Morphological Parameters of In-stent RESTenosis Assessed and Identified by OCT (RESTO)

April 14, 2023 updated by: University Hospital, Clermont-Ferrand

The statistical risk of intrastent stenosis has fallen considerably with the emergence of latest generation coated stents (drug-eluting stents: DES). The number and clinical lifespan of stents implanted over the last twenty-five years, however, explain the fact that restenosis remains a not unusual clinical problem which is expressed as a recurrence of angina or of an acute coronary syndrome (ACS).

The mechanisms involved in this restenosis are multifactorial in nature and differ depending on the type of stent and the time since the restenosis occurred. In symptomatic stent restenosis (angina or acute coronary syndrome), a further angioplasty is usually required, occasionally on an emergency basis. Coronary angiography is often not capable of explaining the mechanical causes of this complication.

Optical coherence tomography (OCT), a high-resolution endocoronary imaging technique can assist in the understanding of the mechanism of restenosis and guide treatment. OCT during angiography provides a detailed analysis of the stents and potential complications: the presence of neoatherosclerosis with or without plaque rupture, intimal hyperplasia, stent under-deployment, stent fracture and distal or proximal progression of the atherosclerosis.

The investigators propose a prospective, multicentre study of all cases of intrastent restenosis, examined by angiography, causing clinical features involving stable angina and acute coronary syndrome. The coronary artery involved will be routinely studied by OCT for a mechanical cause of the intrastent restenosis. The routine use of intrastent OCT may assist in the understanding of causes of restenosis and in the decision on appropriate treatment. There are several possible treatments for restenosis, including balloon angioplasty, coated balloon angioplasty, stenting or aorto-coronary bypass graft surgery.

Study Overview

Status

Completed

Conditions

Detailed Description

All stented coronary artery patients hospitalised for stable angina or an ACS requiring a further coronary angiogram (regardless of time since implantation or type of the initial stent) identified to have intrastent restenosis during coronary angiography will be included after being informed and obtaining their informed written consent.

  • For cases of stable angina the OCT the will be performed immediately with insertion of the probe distal to the area being studied and then automatic retraction of the fibre during injection of the contrast medium.
  • For ACS, the OCT will be performed immediately or on a deferred basis at the discretion of the operator.
  • For critical lesions which prevent the OCT fibre passing across the lesion, "soft" predilatation with a 2 mm or smaller balloon is permitted.
  • Practical conduct of the OCT:

    • Pullback at baseline state and analysis of the stent with a 5 mm margin proximal and distal to the lesion.
    • OCT analysis: under-deployment of the stent (expansion < 80% of the reference mean surface area), neoatherosclerosis with or without rupture, homogeneous or non-homogeneous hyperplasia, stent fracture and proximal or distal progression of the atherosclerosis.
    • Final pullback in cases of a new angioplasty (balloon angioplasty, angioplasty with a coated balloon or stenting).
  • The OCT investigations will be anonymised and registered in their original format with a view to centralised reading (Corelab ISIT, UMR 6284-CNRS, Clermont-Ferrand University).
  • The angiography records will be submitted for reading by a panel blinded to the OCT for the purposes of demonstrating the added value of OCT in the fine details of diagnosis and the impact of a treatment decision. The angiograms will be reviewed in a centralised analytical laboratory, which will re-read the procedures blind.
  • Patients will be followed up via telephone contact or visit one year after inclusion into the study to record any complications which have developed (possible myocardial infarction, reason, any new revascularisation of the target lesion or another artery and reason for this, any deaths and their causes).

Study Type

Interventional

Enrollment (Actual)

307

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

      • Leuven, Belgium
        • Université- Hôpital Leuven
      • Aubervilliers, France
        • Clinique la Roseraie
      • Avignon, France
        • CH Avignon
      • Besançon, France
        • CHRU Besançon
      • Bordeaux, France
        • CHU Bordeaux
      • Brest, France
        • CHRU Morvan
      • Cauro, France
        • Hôpital Privé Saint Martin
      • Chartres, France
        • Centre Hospitalier les Hôpitaux de Chartres
      • Grenoble, France
        • CHRU Grenoble Alpes
      • La Roche-sur-Yon, France
        • Centre Hospitalier Départemental VENDEE
      • Lille, France
        • CHRU Lille
      • Lyon, France
        • Hospices Civiles Lyon
      • Lyon, France
        • Centre Hospitalier Saint Joseph Saint Luc
      • Marseille, France
        • AP-HM
      • Nîmes, France
        • CHRU Nîmes
      • Ollioules, France
        • Polyclinique les Fleurs
      • Paris, France
        • AP-HP
      • Paris, France
        • Hôpital Privé Institut Mutualiste Montsouris
      • Poitiers, France
        • CHRU Poitiers
      • Rouen, France
        • Clinique Saint Hilaire
      • Strasbourg, France
        • CHRU Strasbourg
      • Toucy, France
        • Clinique Pasteur Toulouse
      • Toulouse, France
        • CHRU Toulouse
      • Tours, France
        • CHRU Hôpitaux De Tours
    • Auvergne
      • Clermont-Ferrand, Auvergne, France, 63000
        • CHU Clermont Ferrand
      • Bern, Switzerland
        • CH de Bern
      • Lausanne, Switzerland
        • CHUV de Lausanne

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

Description

Inclusion Criteria:

  • Men or women, aged 18 years and over.
  • Uncoated, coated or bioresorbable stent restenosis, defined by lumen obstruction of over 50% in the stent and/or within 5 mm proximal or distal to the stent found on coronary angiography.
  • Patients treated for an acute coronary syndrome in which restenosis is suspected. It is recommended that OCT be performed after restoring TIMI grade 3 coronary flow in the initial investigation or in a later review at < 7 days.
  • Patient informed consent.
  • Subscription to a social security system.

Exclusion Criteria:

  • Technical inability to perform the OCT (distal lesions, severe chronic renal failure).
  • Contraindication to the use of ABBOTT systems when insertion of any type of catheter represents a risk to the patient. The contraindications include the following:

    • Bacteraemia or septicaemia
    • Significant coagulation system abnormalities
    • Patients in whom coronary artery spasm has been diagnosed
    • Patients who do not meet the criteria for coronary artery bypass grafting
    • Patients who do not meet the criteria for percutaneous coronary angioplasty
    • Severe haemodynamic shock or instability
    • Total occlusion
  • Life expectancy of under one year for non-cardiac reasons.
  • Pregnant or breast-feeding women or women who are fertile and not taking appropriate contraceptives.
  • Patients under legal protection or guardianship

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

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: OCT

Patient witch coronary artery disease who has been stented and is hospitalised for stable angina or acute coronary syndrome requiring a further coronary angiogram (regardless of time since implantation or type of the initial stent.

- Identification of intrastent restenosis during coronary angiography and realisation of an immediate or deferred OCT.

The OCT fibre is an optical fibre catheter containing a lens located at its extremity and positioned distal to the arterial segment to be examined. This is an intracoronary, very high-resolution section technique based on absorption and reflection of close infrared light by stents and tissues.

OCT analysis is performed during a usual coronary angiography procedure. It is a common technique already used and recommended for intrastent restenosis to establish the mechanism of the process. No new product is being tested. The examination performed is the same.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Characteristics of morphological abnormalities, seen on OCT on millimetre sections of the whole stented segment (5 mm proximally and distally to the stent), potentially responsible for the intrastent restenosis
Time Frame: day 0
Under-deployment of the stent with percentage under-deployment is defined when the minimum intrastent surface area is less than 80% of the reference surface area.
day 0
Characteristics of morphological abnormalities, seen on OCT on millimetre sections of the whole stented segment (5 mm proximally and distally to the stent), potentially responsible for the intrastent restenosis
Time Frame: day 0
Homogeneous or non-homogeneous intimal hyperplasia.
day 0
Characteristics of morphological abnormalities, seen on OCT on millimetre sections of the whole stented segment (5 mm proximally and distally to the stent), potentially responsible for the intrastent restenosis
Time Frame: day 0
Presence of neoatherosclerosis, with or without rupture.
day 0
Characteristics of morphological abnormalities, seen on OCT on millimetre sections of the whole stented segment (5 mm proximally and distally to the stent), potentially responsible for the intrastent restenosis
Time Frame: day 0
Stent fracture .
day 0
Characteristics of morphological abnormalities, seen on OCT on millimetre sections of the whole stented segment (5 mm proximally and distally to the stent), potentially responsible for the intrastent restenosis
Time Frame: day 0
Progression of the proximal or distal atherosclerosis .
day 0

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Clinical data
Time Frame: day 0
time to onset of intrastent restenosis
day 0
Clinical data
Time Frame: day 0
sex
day 0
Clinical data
Time Frame: day 0
age
day 0
Clinical data
Time Frame: day 0
past history of angioplasty
day 0
Clinical data
Time Frame: day 0
myocardial infarction
day 0
Clinical data
Time Frame: day 0
coronary artery bypass grafting
day 0
Clinical data
Time Frame: day 0
multi-vessel disease
day 0
Clinical data
Time Frame: day 0
prosthetic valve
day 0
Clinical data
Time Frame: day 0
heart failure
day 0
Clinical data
Time Frame: day 0
chronic renal failure
day 0
Clinical data
Time Frame: day 0
atrial fibrillation
day 0
Clinical data
Time Frame: day 0
valve disease
day 0
Clinical data
Time Frame: day 0
vascular disease
day 0
Clinical data
Time Frame: day 0
CVA
day 0
Clinical data
Time Frame: day 0
TIA
day 0
Cardiovascular risk factors
Time Frame: day 0
hypertension
day 0
Cardiovascular risk factors
Time Frame: day 0
dyslipidaemia
day 0
Cardiovascular risk factors
Time Frame: day 0
diabetes
day 0
Cardiovascular risk factors
Time Frame: day 0
family history
day 0
Cardiovascular risk factors
Time Frame: day 0
overweight (BMI > 25)
day 0
Cardiovascular risk factors
Time Frame: day 0
smoking habit
day 0
Blood sample
Time Frame: day 0, day 365
Measure of LDL cholesterol
day 0, day 365
Blood sample
Time Frame: day 0, day 365
Measure of HDL cholesterol
day 0, day 365
Blood sample
Time Frame: day 0, day 365
Measure of triglycerides
day 0, day 365
Blood sample
Time Frame: day 0, day 365
Measure of HbA1c
day 0, day 365
Blood sample
Time Frame: day 0, day 365
Measure of creatinine
day 0, day 365
Blood sample
Time Frame: day 0, day 365
Measure of renal clearance
day 0, day 365
New revascularisation events
Time Frame: day 365
new revascularisation event in the target lesion or another artery, myocardial infarctions, deaths and causes of events
day 365

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Collaborators

Investigators

  • Principal Investigator: Géraud Souteyrand, University Hospital, Clermont-Ferrand

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)

December 11, 2019

Primary Completion (Actual)

December 6, 2022

Study Completion (Actual)

December 6, 2022

Study Registration Dates

First Submitted

February 10, 2020

First Submitted That Met QC Criteria

February 11, 2020

First Posted (Actual)

February 13, 2020

Study Record Updates

Last Update Posted (Actual)

April 18, 2023

Last Update Submitted That Met QC Criteria

April 14, 2023

Last Verified

April 1, 2023

More Information

Terms related to this study

Other Study ID Numbers

  • RBHP 2019 SOUTEYRAND
  • 2019-A02305-52 (Other Identifier: 2019-A02305-52)

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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