Chronic Total Occlusion Percutaneous Coronary Intervention Study (CTO-PCI)

Chronic Total Occlusion Percutaneous Coronary Intervention CTO-PCI Study

The objective of this study is to evaluate angiographic confirmation of placement of any guidewire beyond the CTO, in the true vessel lumen, in patients undergoing CTO percutaneous coronary intervention (PCI) in which at least one Teleflex guidewire and at least one Turnpike catheter are used.

Study Overview

• Status: Completed
• Conditions: Ischemic Heart Disease; Chronic Total Occlusion; Chronic Total Occlusion of Coronary Artery
• Intervention / Treatment: Procedure: Chronic Total Occlusion Revascularization; Device: GuideLiner® V3 catheter, TrapLiner® catheter, Turnpike® catheter

Detailed Description

A prospective, multicenter, single-arm, intent-to-treat, literature-controlled clinical study. The study will be conducted in up to 15 investigational sites in the U.S. This study will enroll up to 150 patients to provide adequate powering for hypothesis testing and an evaluable sample size of at least 135 patients.

The population for this study is participants with signs and/or symptoms considered typical of ischemic heart disease attributed to a de novo CTO in a native coronary artery who are suitable candidates for a percutaneous revascularization.

Study devices include the GuideLiner® V3 catheter, TrapLiner® catheter, Turnpike® catheter, and a series of five coronary guidewires (SpectreTM guidewire, R350TM guidewire, RaiderTM guidewire, WarriorTM guidewire, and BanditTM guidewire). All study devices are currently 510(k) cleared for non-CTO indications.

• GuideLiner catheters are intended to be used in conjunction with guide catheters to access discrete regions of the coronary and/or peripheral vasculature, to facilitate placement of interventional devices, and to assist in crossing de novo chronic total occlusions (CTO).
• The TrapLiner catheter is intended for use in conjunction with guide catheters to access discrete regions of the coronary and/or peripheral vasculature, to facilitate placement of interventional devices, to facilitate the exchange of an interventional device while maintaining the position of a guidewire within the vasculature, and to assist in crossing de novo chronic total occlusions (CTO).
• The Turnpike catheters are intended to be used to access discrete regions of the coronary and/or peripheral vasculature. They may be used to facilitate placement and exchange of guidewires, to subselectively infuse/deliver diagnostic and therapeutic agents, and to assist in crossing de novo coronary chronic total occlusions (CTO). The Teleflex guidewires are intended for use in percutaneous procedures to introduce and position catheters and other interventional devices within the coronary and peripheral vasculature, including use in crossing or assisting in crossing de novo coronary chronic total occlusions (CTO).

• Study Type: Interventional
• Enrollment (Actual): 150
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • California
    • Torrance, California, United States, 90505
      • Torrance Memorial Medical Center
  • Georgia
    • Atlanta, Georgia, United States, 30322
      • Emory University
    • Atlanta, Georgia, United States, 30309
      • Piedmont Heart Institute
  • Massachusetts
    • Boston, Massachusetts, United States, 02215
      • Beth Israel Deaconess Medical Center
    • Boston, Massachusetts, United States, 02115
      • Brigham and Women's Hospital
    • Boston, Massachusetts, United States, 02214
      • Massachusetts General Hospital
  • Michigan
    • Detroit, Michigan, United States, 48202
      • Henry Ford Hospital
  • Minnesota
    • Minneapolis, Minnesota, United States, 55407
      • Minneapolis Heart Institute Foundation
  • Missouri
    • Columbia, Missouri, United States, 65201
      • Missouri Cardiovascular Specialists
  • New York
    • New York, New York, United States, 10032
      • Columbia University Medical Center
    • New York, New York, United States, 10016
      • NYU Langone Health
  • Ohio
    • Cincinnati, Ohio, United States, 45219
      • The Christ Hospital
  • Washington
    • Seattle, Washington, United States, 98195
      • University of Washington

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 14 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

Participants must meet all of the following inclusion criteria:

General inclusion criteria

1. At least 18 years of age at the time of consent
2. Experiencing clinical symptoms considered suggestive of ischemic heart disease (e.g., chest pain or discomfort, heart failure) or has evidence of myocardial ischemia (e.g., abnormal functional study) attributed to the CTO target vessel and is scheduled for clinically indicated percutaneous revascularization
3. Participant is eligible and consents to undergo PCI procedure
4. Acceptable candidate for percutaneous transluminal coronary angioplasty (PTCA), stenting, and emergency coronary artery bypass grafting (CABG)
5. Willing and able to sign a study Informed Consent Form (ICF) approved by a local or central Institutional Review Board (IRB)

6. Female participants of childbearing potential must have a negative pregnancy test per standard of care for PCI and be practicing contraception

   Angiographic inclusion criteria

7. A minimum of one de novo lesion with at least one target segment in a native coronary vessel meeting the definition of CTO (any non-acute total coronary occlusion fulfilling the angiographic characteristics consistent with high-grade native coronary stenosis (Thrombolysis in Myocardial Infarction (TIMI) score of 0 or 1) and estimated to be in duration of ≥ 3 months by clinical history and/or comparison with antecedent angiogram or electrocardiogram)

Exclusion Criteria:

Participants must not meet any of the following exclusion criteria:

General exclusion criteria

1. History of allergy to iodinated contrast that cannot be effectively managed medically
2. Evidence of acute myocardial infarction (MI) within 72 hours prior to the intended treatment defined as creatine kinase-muscle brain subunits (CK-MB) greater than 3 times the upper limit of normal (ULN)
3. Previous coronary interventional procedure of any kind within 30 days prior to the procedure
4. Any contraindication to cardiac catheterization or to any of the standard concomitant therapies used during routine cardiac catheterization and PCI (e.g., aspirin, clopidogrel, unfractionated heparin)
5. Target lesion requires treatment with another device, after successful crossing with a study device, other than PTCA devices prior to stent placement
6. Atherectomy procedure is planned for the target lesion

7. Known history of clinically significant abnormal laboratory findings ≤ 14 days prior to enrollment, including:

   • Neutropenia (<1000 neutrophils/mm^3)
   • Thrombocytopenia (<100,000 platelets/mm^3)
   • Aspartate aminotransferase (AST), alanine transaminase (ALT), alkaline phosphatase, or bilirubin > 1.5 × ULN
   • Serum creatinine >2.0 mg/dL

8. Evidence of current clinical instability including the following:

   • Sustained systolic blood pressure <100 mmHg or cardiogenic shock
   • Acute pulmonary edema or severe congestive heart failure (CHF). Severe CHF is defined as New York Heart Association (NYHA) Class IV
   • Suspected acute myocarditis, pericarditis, endocarditis, or cardiac tamponade
   • Suspected dissecting aortic aneurysm
   • Hemodynamically significant valvular heart disease, hypertrophic cardiomyopathy, restrictive cardiomyopathy, or congenital heart disease
9. History of stroke or transient ischemic attack within 6 months prior to procedure
10. Active peptic ulcer or upper gastrointestinal bleeding within 6 months prior to procedure
11. History of bleeding diathesis or coagulopathy or refusal of blood transfusions
12. Other pathology such as cancer, known mental illness, etc., which might, in the opinion of the Investigator, put the patient at risk or confound the results of the study
13. Unable or unwilling to comply with the protocol

14. Currently participating in an investigational drug or device study that has not completed the primary endpoint or that clinically interferes with the current study endpoints; or requires coronary angiography, intravascular ultrasound, or other coronary artery imaging procedures

    Angiographic exclusion criteria

15. Occlusion involves segment within previous stent ("in-stent occlusions")
16. Extensive lesion-related thrombus (TIMI thrombus grade 3 or 4)

17. Previous stenting (drug-eluting or bare metal) in the target vessel unless the following conditions are met:

    • It has been at least 9 months since the previous stenting
    • Target lesion is ≥15 mm away from the previously placed stent
    • Previously stented segment (stent plus 5 mm on either side) has no more than 40 percent diameter stenosis, based on visual estimate
18. Target vessel has other lesions proximal to the total occlusion identified with > 75 percent diameter stenosis based on visual estimate; exception: planned stenting of a lesion proximal to the target lesion that can be covered by a single stent (i.e., tandem lesions) is acceptable

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Other: Chronic Total Occlusion Percutaneous Coronary Intervention; CTO percutaneous coronary intervention (PCI) in which at least one Teleflex guidewire and at least one Turnpike catheter are used.

Procedure: Chronic Total Occlusion Revascularization; Teleflex's series of study guidewires and catheters will be used to facilitate the safe and effective crossing of de novo CTOs and placement of conventional guidewires beyond the lesion via either a true lumen or subintimal pathway.; Device: GuideLiner® V3 catheter, TrapLiner® catheter, Turnpike® catheter; GuideLiner® V3 catheter, TrapLiner® catheter, Turnpike® catheter

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Participants With Procedure Success	Defined as angiographic visualization of any guidewire in a position either distal or proximal to the occlusion depending on the route of access and the absence of in-hospital major adverse cardiac events (MACE). • MACE defined as any serious adverse experience that includes cardiac death, target lesion revascularization, or post-procedural myocardial infarction (MI) (Q-wave or non-Q-wave, with creatine kinase (CK) with Muscle (M)-Brain (B) subunits > 3 ULN).	Through Discharge up to 24 hours post-procedure

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Participants With Successful Recanalization.	Defined as angiographic confirmation of crossing the chronic total occlusion and restoring blood flow to the affected area.	Through Procedure, up to 4 hours
Number of Participants With In-hospital MACE.	Defined as any serious adverse experience that includes cardiac death, target lesion revascularization, or post-procedural MI (Q-wave or non-Q-wave, with CK-MB > 3 ULN). The components of MACE will also be reported separately.	Through Discharge up to 24 hours
Number of Participants With Clinically Significant Perforation.	Defined as any perforation resulting in hemodynamic instability and/or requiring intervention including pericardiocentesis, embolization, prolonged balloon occlusion, stent graft, or comparable therapy.	Through Procedure up to 4 hours
Number of Participants With Procedural Success According to Crossing Technique.	Procedural success is defined as angiographic visualization of any guidewire in a position either distal or proximal to the occlusion depending on the route of access and the absence of in-hospital major adverse cardiac events (MACE).	Through Procedure up to 4 hours post-procedure
Number of Participants With Technical Success.	Defined as successful guidewire recanalization is applicable to investigational devices as at least one investigational guidewire must be used in every procedure.	Through Procedure up to 4 hours post-procedure

Collaborators and Investigators

• Sponsor: Vascular Solutions LLC
• Collaborators: Bright Research Partners; Teleflex
• Investigators: Principal Investigator: David E Kandzari, MD, Piedmont Heart Institute; Principal Investigator: Dimitrios Karmpaliotis, MD, PhD, Columbia University

Publications and helpful links

General Publications

• Kandzari DE, Alaswad K, Jaffer FA, Brilakis E, Croce K, Kearney K, Spaedy A, Yeh R, Thompson C, Nicholson W, Wyman RM, Riley R, Lansky A, Buller C, Karmpaliotis D. Safety and efficacy of dedicated guidewire, microcatheter, and guide catheter extension technologies for chronic total coronary occlusion revascularization: Primary results of the Teleflex Chronic Total Occlusion Study. Catheter Cardiovasc Interv. 2022 Feb;99(2):263-270. doi: 10.1002/ccd.29962. Epub 2021 Sep 28.

Study record dates

Study Major Dates

• Study Start (Actual): May 20, 2020
• Primary Completion (Actual): February 22, 2021
• Study Completion (Actual): February 22, 2021

Study Registration Dates

• First Submitted: June 13, 2019
• First Submitted That Met QC Criteria: June 14, 2019
• First Posted (Actual): June 17, 2019

Study Record Updates

• Last Update Posted (Actual): September 28, 2022
• Last Update Submitted That Met QC Criteria: September 13, 2022
• Last Verified: October 1, 2021

More Information

Terms related to this study

• Keywords: Chronic Total Occlusion; Percutaneous revascularization
• Additional Relevant MeSH Terms: Cardiovascular Diseases; Vascular Diseases; Arteriosclerosis; Arterial Occlusive Diseases; Coronary Disease; Heart Diseases; Coronary Artery Disease; Myocardial Ischemia
• Other Study ID Numbers: ST2955

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: Yes