- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05873816
The PROTEMBO Trial
Cerebral Protection in Transcatheter Aortic Valve Replacement: The PROTEMBO Trial
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Subjects with severe symptomatic aortic stenosis undergoing TAVR will be able to participate. Participants will be randomized in a 2:1:1 fashion to either the ProtEmbo arm, the Sentinel arm, or the 'No device' arm.
Enrolled subjects will undergo an MRI at baseline and at 36 hours ±12 hours, to evaluate any new cerebral lesions. Enrolled subjects will be followed for 30 days.
The study aims to address:
- whether the occurrence of all Major Adverse Cardiac and Cerebrovascular Events (MACCE) at 30 days is comparable between the ProtEmbo group and the hybrid control group.
- whether the total new lesion volume in the brain assessed by diffusion weighted magnetic resonance images at 36 ±12 hours is comparable between the ProtEmbo group and the hybrid control group.
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Nawzer Mehta, PhD
- Phone Number: +1 707 293 5435
- Email: nm@protembis.com
Study Contact Backup
- Name: Karl von Mangoldt
- Phone Number: +49-178-8164564
- Email: kvm@protembis.com
Study Locations
-
-
Florida
-
Clearwater, Florida, United States, 33756
- Recruiting
- BayCare Health System / Morton Plant Hospital
-
Contact:
- Beth Schelle
- Email: Mary.Schelle@baycare.org
-
Principal Investigator:
- Joshua Rovin, MD
-
Contact:
- Susan Fisher
- Email: susan.fisher1@baycare.org
-
-
New York
-
Buffalo, New York, United States, 14203
- Recruiting
- State University of New York at Buffalo
-
Contact:
- Courtney Bishop
- Email: cabishop@buffalo.edu
-
Principal Investigator:
- Vijay Iyer, MD
-
Contact:
- Shannon Allen
- Email: seallen@buffalo.edu
-
New York, New York, United States, 10032
- Recruiting
- Columbia University Medical Center / NYPH
-
Contact:
- Kate Dalton, MS
- Phone Number: 347-514-3366
- Email: keb2114@cumc.columbia.edu
-
Principal Investigator:
- Vivian Ng, MD
-
Sub-Investigator:
- Susheel Kodali, MD
-
New York, New York, United States, 10065
- Recruiting
- Weill Medical College / Cornell University
-
Contact:
- Dolores Reynolds
- Email: dtr2001@med.cornell.edu
-
Principal Investigator:
- Shin Chiu Wong, MD
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- The heart team recommends transcatheter aortic valve replacement via femoral access consistent with the 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease.
- The subject and the treating physician agree that the subject will undergo the scheduled pre procedural testing and return for all required post procedure follow up visits.
- The subject is able to provide informed consent, has been informed of the nature of the trial, agrees to its provisions and has provided written informed consent as approved by the relevant regulatory authority of the respective clinical site.
- Subject is a minimum of 18 years of age.
Exclusion Criteria:
General exclusion criteria:
- Subject is a woman of child-bearing potential.
- Arm anatomy/ vasculature precluding radial or brachial artery access.
- Hemodialysis shunt, graft, or arterio-venous fistula involving the upper extremity vasculature.
- Evidence of an acute myocardial infarction ≤ 1 month before the intended treatment.
- Severe ventricular dysfunction with LVEF ≤25%.
- Any therapeutic invasive cardiac procedure resulting in a permanent implant that is performed within 10 days of the index procedure.
- Blood dyscrasias as defined by clinically significant leukopenia (< 500 leukocytes / μL), acute anemia (Hgb < 8 g / dL), thrombocytopenia (< 80,000 platelets / μl), history of bleeding diathesis or coagulopathy.
- Hemodynamic instability, or pressure dependence requiring pharmacological inotropic support or mechanical heart assistance.
- Echocardiographic evidence of intracardiac or aortic mass, thrombus not adequately treated, or vegetation.
- Active peptic ulcer or upper GI bleeding within the prior 6 months.
- Contraindication for anticoagulant or antiplatelet therapy.
- Renal insufficiency (creatinine > 3.0 mg / dL or GFR < 30) and / or renal replacement therapy at the time of screening and dialysis patients.
- Current or planned treatment with any investigational drug or investigational device during the study follow-up period (30 days).
- Balloon aortic valvuloplasty (BAV) within 30 days of the procedure.
- Cardiogenic shock, hemodynamic instability, or severe hypotension (systolic blood pressure < 90 mm Hg) at the time of the index procedure.
- Cardiovascular surgical or interventional procedure 10 days prior or planned during the TAVR procedure or during the 30-day study follow-up.
- Patients with severe chronic obstructive pulmonary disease (COPD)
NOTE: Use of general anesthesia during TAVR may affect neurocognitive function shortly after the procedure. While not an exclusion criterion, it is recommended that general anesthesia not be used if possible.
Neurological exclusion criteria:
- Cerebrovascular event including TIA within 6 months of the procedure.
- Subject had active major psychiatric disease.
- Subject has severe visual, auditory, or learning impairment and is unable to comprehend English or local language and therefore unable to be consented for the study.
- Subjects with neurodegenerative or other progressive neurological disease or history of significant head trauma followed by persistent neurologic defaults or known structural brain abnormalities.
Magnetic resonance imaging exclusion criteria:
- Body Mass Index (BMI) precluding imaging in scanner.
- Contraindications to MRI (subjects with any implantable temporary or permanent pacemaker or defibrillator, metal implants in field of view, metallic fragments, clips, or devices in the brain or eye before TAVR procedure).
- High risk of complete AV block after TAVR, with the need of permanent pacemaker (e.g., subjects with pre-existing bifascicular block or complete right bundle branch block plus any degree of AV block).
- Planned implantation of a pacemaker or defibrillator implantation within the first 3 days after TAVR.
- Claustrophobia precluding MRI scanning.
Anatomical and CT exclusion criteria:
- Excessive tortuosity in left subclavian artery (≥ 70° single kink or ≥ 50° in sequential kinks).
- Excessive tortuosity in right vascular access vessels for Sentinel introduction.
- Significant stenosis (≥ 70%), calcification, ectasia, dissection, occlusion, aneurysm, or severe peripheral arterial disease in left or right arm access vessels - in particular at or within 3 cm of the aortic ostia.
- Left subclavian artery diameter is ≤ 4 mm.
- Brachiocephalic artery at the site of Sentinel filter placement < 9 mm or > 15 mm.
- Left common artery at the site of Sentinel filter placement < 6.5 mm or > 10 mm.
- Symptomatic or asymptomatic severe (≥ 70%) occlusive carotid disease requiring concomitant CEA / stenting.
- Inner diameter of aortic arch < 25 mm as measured in any position between ascending aorta and ostium of left subclavian artery.
- Distance between the origin of left subclavian artery and valve plain of < 90 mm.
- Common ostium of cerebral vessels, where all three vessels originate from one single ostium in the aortic arch.
- Significant stenosis, ectasia, dissection, aneurysm, or atheroma (mobile or > 5 mm thick) in the ascending aorta or in the aortic arch.
- Significant angulation of the proximal segment of the left subclavian or aortic arch angulation or abnormal anatomical conditions of the aorta (a Type 3 aortic arch is not a reason for exclusion).
- Distance between the origin of brachiocephalic trunk and left subclavian artery of > 65 mm.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: ProtEmbo - Cerebral Embolic Protection
Subjects will undergo TAVR following placement of the ProtEmbo cerebral embolic protection device.
|
Subjects will undergo TAVR following placement of the ProtEmbo cerebral embolic protection device.
|
Active Comparator: Sentinel - Cerebral Embolic Protection
Subjects will undergo TAVR following placement of the Sentinel cerebral embolic protection device.
|
Subjects will undergo TAVR following placement of the Sentinel cerebral embolic protection device.
|
No Intervention: Control Arm
Subjects will undergo TAVR without embolic protection.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
MACCE at 30 days
Time Frame: Up to Day 30 post procedure
|
Occurrence of Major Adverse Cardiac and Cerebrovascular Events (MACCE) at 30 days defined as all-cause mortality, all stroke, life-threatening or disabling bleeding, major vascular complications, and acute kidney injury (stage 2 or 3) as defined by VARC-3.
|
Up to Day 30 post procedure
|
Total new lesion volume
Time Frame: 36 ±12 hours post TAVR procedure
|
Total new lesion volume (TNLV) in the brain assessed by diffusion weighted magnetic resonance imaging (DW-MRI) at 36 ±12 hours.
|
36 ±12 hours post TAVR procedure
|
Collaborators and Investigators
Sponsor
Investigators
- Study Chair: Roxana Mehran, MD, Icahn School of Medicine at Mount Sinai
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- CIP_00250
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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