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Vergleich von zwei PFO-Verschlussvorrichtungen bei Erwachsenen mit vorangegangenem Schlaganfall oder TIA (SAFE-PFO)

30. September 2026 aktualisiert von: Giuseppe Tarantini

Randomisierte kontrollierte Studie zur Vergleich der Sicherheit und Wirksamkeit des Cocoon PFO-Okkluders gegenüber dem Amplatzer PFO-Verschlussgerät für den perkutanen Verschluss des persistierenden Foramen ovale bei Patienten mit einer Vorgeschichte von Schlaganfall oder transitorisch ischämischer Attacke – Eine gemeinnützige, einfachblinde, untersuchungsgetriebene Studie

This study is a prospective, multicenter, randomized, controlled, single-blind, investigator-driven, non-profit clinical trial designed to compare the safety and efficacy of the Cocoon PFO Occluder with the Amplatzer PFO Occluder family in patients requiring percutaneous closure of a patent foramen ovale (PFO). Eligible participants are adults with a history of cryptogenic embolic stroke or neurologically confirmed transient ischemic attack (TIA) within the previous 12 months and a PFO suitable for transcatheter closure.

A total of up to 1260 subjects will be enrolled across multiple European centers. Participants will be randomly assigned in a 3:1 ratio to receive either the Cocoon PFO Occluder (experimental group) or an Amplatzer PFO closure device (control group). The procedure will be performed as soon as possible after randomization, preferably within 14 days and no later than 45 days.

The primary endpoint is a non-inferiority comparison of a composite outcome at 12 months, including recurrent ischemic stroke, TIA, or all-cause death. Secondary endpoints include PFO closure rate at 6 months, assessed by echocardiographic imaging, and other measures of safety, device performance, and clinical outcomes.

The study is conducted in a single-blind fashion: patients will not be informed of the device they receive unless they explicitly request this information. Any patient who chooses to be unblinded will continue to participate without affecting eligibility or follow-up, and the date of unblinding will be documented to allow appropriate sensitivity analyses.

This trial aims to provide robust comparative evidence on the clinical performance of the Cocoon PFO Occluder relative to the Amplatzer PFO Occluder to guide optimal device selection in patients with cryptogenic stroke or TIA associated with PFO.

Studienübersicht

Status

Rekrutierung

Bedingungen

Intervention / Behandlung

Studientyp

Interventionell

Einschreibung (Geschätzt)

1260

Phase

  • Unzutreffend

Kontakte und Standorte

Dieser Abschnitt enthält die Kontaktdaten derjenigen, die die Studie durchführen, und Informationen darüber, wo diese Studie durchgeführt wird.

Studienkontakt

Studieren Sie die Kontaktsicherung

Studienorte

    • North Rhine-Westphalia (Nordrhein-Westfalen)
      • Bad Oeynhausen, North Rhine-Westphalia (Nordrhein-Westfalen), Deutschland, 32545
        • Rekrutierung
        • Heart and Diabetes Center NRW (HDZ NRW), Clinic for General and Interventional Cardiology/Angiology
        • Hauptermittler:
          • Werner Scholtz, MD
        • Kontakt:
          • Werner Scholtz, MD

Teilnahmekriterien

Forscher suchen nach Personen, die einer bestimmten Beschreibung entsprechen, die als Auswahlkriterien bezeichnet werden. Einige Beispiele für diese Kriterien sind der allgemeine Gesundheitszustand einer Person oder frühere Behandlungen.

Zulassungskriterien

Studienberechtigtes Alter

18 Jahre bis 65 Jahre (Erwachsene, Älterer Erwachsener)

Akzeptiert gesunde Freiwillige

Nein

Studienberechtigte Geschlechter

Alle

Beschreibung

Inclusion Criteria:

  • Patients with >18 years of age and <65 years of age, regardless of gender
  • Patients with normal or aneurysm type PFO confirmed by imaging examination [Transthoracic Echocardiography (TTE)/ Transesophageal Echocardiography (TOE) or Intracardiac Echocardiography], and who exhibit spontaneous right-to-left shunting or right-to-left shunting during Valsalva maneuver.
  • Patients with history of cryptogenic embolic stroke or transient ischemic attack in the previous 12 months [stroke is defined as acute focal neurological deficit presumed to be due to focal ischemia, and either 1) symptoms persisting 24 hours or greater, or 2) symptoms persisting less than 24 hours but associated with MR or CT findings of a new, neuroanatomically relevant, cerebral infarct. Transient Ischemic Attack is defined as acute focal neurological deficit (defined as focal motor deficit, aphasia, difficulty walking, hemisensory deficit, amaurosis fugax, blindness, or focal visual deficit) presumed due to focal ischemia, lasting between 5 minutes and 24 hours, that is not associated with MR or CT findings of a new cerebral infarct]. The diagnosis of cryptogenic embolic stroke or TIA has to be confirmed by a neurologist.
  • The size of PFO must be amenable to selection of a Cocoon PFO Occluder or Amplatzer PFO closure device.
  • Patients are informed of the nature of the trial and agree to all requirements for participation in the trial, signed the informed consent form, and agreed to complete the follow-up and follow-up examination

Exclusion Criteria:

  • Patients who have definite causes of stroke or transient ischemic attack unrelated to the PFO
  • RLS caused by other causes, such as atrial septal defect or pulmonary arteriovenous shunt
  • Patients with atrial fibrillation/atrial flutter (chronic or intermittent) Intracardiac thrombus or tumor
  • Patients with mitral or aortic valve stenosis or severe regurgitation
  • Mitral or aortic valve vegetation or prosthesis
  • Active endocarditis or other untreated infectious diseases
  • Dilated cardiomyopathy, hypertrophic cardiomyopathy, restrictive cardiomyopathy
  • Left ventricular ejection fraction (LVEF) <35%
  • Left ventricular aneurysm or akinesis Myocardial infarction or unstable angina pectoris within 12 months
  • Previous intracardiac surgery or percutaneous PFO-closure
  • Atherosclerosis or arteriopathy of intra- or extracranial vessels with >50% diameter stenosis in the artery supplying the infarcted territory.
  • Patients with non-embolic cryptogenic stroke (for example lacunar stroke) or with other identifiable causes of stroke, including but not limited to aortic arch plaques (protruding >4 mm into the lumen), large artery atherosclerotic disease, an established cardioembolic source, small-vessel occlusive disease, or arterial dissection
  • Glomerular filtration rate < 30 ml/min/1.73 m2 or with any history of renal dialysis or renal transplantation
  • Severe liver function impairment (alanine aminotransferase (ALT) or aspartate aminotransferase (AST) greater than 3 times the upper limit of normal value)
  • Severe pulmonary disease including pulmonary hypertension (clinical diagnosis)
  • Uncontrollable hypertension or diabetes mellitus
  • Contraindications to anticoagulants or antiplatelet drugs, either before or after the PFO closure procedure
  • Active or planned (within 12 months) pregnancy, or lactating female patients
  • Patients with hypercoagulable states
  • Patients diagnosed with a neurological disease that causes progressive neurological dysfunction
  • Malignant tumors or other serious diseases resulting in a life expectancy of less than 12 months
  • Anatomy in which the device would interfere with intracardiac or vascular structures
  • Psychiatric conditions that may interfere with medical compliance and compliance with follow-up
  • Patient is currently participating in another investigational drug or device study that has not reached its primary endpoint yet
  • Patient with any medical condition that would make him/her inappropriate for treatment as per the current IFU of respective devices or in the opinion of the Investigator
  • Inability to obtain Informed Consent from patient or legally authorized representatives
  • Stroke with poor outcome at time of enrollment (Modified Rankin score >3)
  • Subjects who will not be available for follow up for the duration of the trial

Studienplan

Dieser Abschnitt enthält Einzelheiten zum Studienplan, einschließlich des Studiendesigns und der Messung der Studieninhalte.

Wie ist die Studie aufgebaut?

Designdetails

  • Hauptzweck: Behandlung
  • Zuteilung: Zufällig
  • Interventionsmodell: Parallele Zuordnung
  • Maskierung: Single

Waffen und Interventionen

Teilnehmergruppe / Arm
Intervention / Behandlung
Experimental: Cocoon PFO Occluder - experimental

Participants undergo percutaneous closure of patent foramen ovale (PFO) using the Cocoon PFO Occluder device. The procedure is performed under standard clinical practice. Follow-up includes echocardiographic assessment of PFO closure and routine clinical evaluations. Participants are assigned to the two study arms using a 3:1 randomization scheme (Cocoon PFO Occluder : Amplatzer PFO Occluder).

Percutaneous PFO closure performed according to standard clinical practice. The procedure is scheduled within 45 days after randomization and includes initiation of dual antiplatelet therapy before the intervention. Closure is performed following the Instructions for Use (IFU) of the assigned device and is guided by intracardiac echocardiography or transesophageal echocardiography. After device implantation, patients undergo routine post-procedure assessment and are instructed to follow antiplatelet therapy consistent with European clinical practice guidelines. Endocarditis prophylaxis is recommended for six months. The procedural steps are identical for both study arms; the only difference is the device implanted (Cocoon PFO Occluder or Amplatzer PFO Occluder). Participants are assigned to the two study arms using a 3:1 randomization scheme (Cocoon PFO Occluder : Amplatzer PFO Occluder).

Aktiver Komparator: Amplatzer PFO Occluder - Control

Participants undergo percutaneous closure of patent foramen ovale (PFO) using the Amplatzer PFO Occluder device, considered the current standard of care. Follow-up includes echocardiographic assessment of PFO closure and routine clinical evaluations. Participants are assigned to the two study arms using a 3:1 randomization scheme (Cocoon PFO Occluder : Amplatzer PFO Occluder).

Percutaneous PFO closure performed according to standard clinical practice. The procedure is scheduled within 45 days after randomization and includes initiation of dual antiplatelet therapy before the intervention. Closure is performed following the Instructions for Use (IFU) of the assigned device and is guided by intracardiac echocardiography or transesophageal echocardiography. After device implantation, patients undergo routine post-procedure assessment and are instructed to follow antiplatelet therapy consistent with European clinical practice guidelines. Endocarditis prophylaxis is recommended for six months. The procedural steps are identical for both study arms; the only difference is the device implanted (Cocoon PFO Occluder or Amplatzer PFO Occluder). Participants are assigned to the two study arms using a 3:1 randomization scheme (Cocoon PFO Occluder : Amplatzer PFO Occluder).

Was misst die Studie?

Primäre Ergebnismessungen

Ergebnis Maßnahme
Maßnahmenbeschreibung
Zeitfenster
Composite endpoint of recurrent ischemic stroke, TIA, or all-cause death at 12 months
Zeitfenster: 12 months after the procedure

A non-inferiority comparison between the Cocoon PFO Occluder and the Amplatzer PFO Occluder in terms of a composite endpoint including:

  1. Recurrent ischemic stroke, defined as an acute focal neurological deficit presumed to result from focal ischemia, with symptoms lasting ≥24 hours, or <24 hours if accompanied by MRI or CT evidence of a new, anatomically relevant cerebral infarct.
  2. Transient ischemic attack (TIA), defined as an acute focal neurological deficit (e.g., focal motor deficit, aphasia, gait disturbance, hemisensory deficit, amaurosis fugax, blindness, or focal visual deficit) presumed due to focal ischemia, lasting between 5 minutes and 24 hours, and not associated with MRI or CT evidence of a new infarct. Clinical evaluation by a neurologist is required.
  3. All-cause mortality.
12 months after the procedure

Sekundäre Ergebnismessungen

Ergebnis Maßnahme
Maßnahmenbeschreibung
Zeitfenster
PFO Closure Rate
Zeitfenster: 6 months

Complete closure is defined as right-to-left shunt (RLS) grade 0. Effective closure is defined as RLS grade 0 or 1 on imaging (TTE as default, TOE when clinically indicated)

6 months
Composite of Recurrent Ischemic Stroke, TIA, or Death
Zeitfenster: 30 days and 6 months

Composite endpoint including recurrent ischemic stroke, TIA (neurologist-confirmed), or all-cause mortality.

30 days and 6 months
Neurological Death
Zeitfenster: 30 days, 6 months, 12 months

Death attributable to neurological causes.

30 days, 6 months, 12 months
Cardiovascular Death
Zeitfenster: 30 days, 6 months, 12 months

Death attributable to cardiovascular causes.

30 days, 6 months, 12 months
Recurrent Symptomatic Non-Fatal Stroke
Zeitfenster: 30 days, 6 months, 12 months

TIA defined according to the same criteria as the primary endpoint and confirmed by a neurologist

30 days, 6 months, 12 months
Serious Adverse Events (SAE)
Zeitfenster: 30 days, 6 months, 12 months

Incidence of any serious adverse event as defined by standard reporting criteria.

30 days, 6 months, 12 months
Device- or Procedure-Related Serious Adverse Events
Zeitfenster: 30 days, 6 months, 12 months

SAE related to the device or procedure, including but not limited to: death, systemic embolism, device embolization or malposition, device thrombosis, cardiac injury/perforation, pericardial tamponade/effusion, endocarditis, atrial fibrillation, and severe vascular access complications

30 days, 6 months, 12 months
Clinically Significant New Atrial Arrhythmia
Zeitfenster: 30 days, 6 months, 12 months

New atrial arrhythmia (including AF) confirmed by ECG, Holter, or approved monitoring device. AF defined per international guidelines (≥30-second episode with absence of P waves and irregular RR intervals).

30 days, 6 months, 12 months
Device Success
Zeitfenster: Immediately after the procedure

Successful delivery, deployment at intended site, and retrieval of the delivery system.

Immediately after the procedure
Procedural Success
Zeitfenster: At hospital discharge

Device success without device- or procedure-related SAE prior to discharge

At hospital discharge
Change in Monthly Migraine Days
Zeitfenster: Months 9-12 vs. baseline (3 months before implantation)

Change in monthly migraine days in patients with a neurologist-confirmed diagnosis of migraine.

Months 9-12 vs. baseline (3 months before implantation)
Quality of Life (SF-36 Score)
Zeitfenster: 6 months, 12 months

Assessment of quality of life using the SF-36 questionnaire.

6 months, 12 months
Systemic Embolism
Zeitfenster: 30 days, 6 months, 12 months

Incidence of systemic embolic events confirmed clinically or by imaging

30 days, 6 months, 12 months
Possible/Probable Device-Related Allergy
Zeitfenster: 12 months

Device-related allergic reactions adjudicated by the Clinical Events Committee (CEC)

12 months
Echocardiographic Markers of Device Endothelialization
Zeitfenster: At 6 months (±1 month) post-procedure At 12 months (±2 months) post-procedure Additional TOE as clinically indicated through study completion (up to 12 months)

Evaluation of endothelialization using surrogate TOE markers: device surface echogenicity, peri-device flow, presence of thrombus/mass, visible disc surface area, and bubble contrast washout. Data will be summarized as the proportion of participants meeting criteria for complete endothelialization at each follow-up time point.

At 6 months (±1 month) post-procedure At 12 months (±2 months) post-procedure Additional TOE as clinically indicated through study completion (up to 12 months)

Mitarbeiter und Ermittler

Hier finden Sie Personen und Organisationen, die an dieser Studie beteiligt sind.

Sponsor

Mitarbeiter

Ermittler

  • Hauptermittler: Giuseppe Tarantini, MD, PhD, FESC, University of Padova

Publikationen und hilfreiche Links

Die Bereitstellung dieser Publikationen erfolgt freiwillig durch die für die Eingabe von Informationen über die Studie verantwortliche Person. Diese können sich auf alles beziehen, was mit dem Studium zu tun hat.

Allgemeine Veröffentlichungen

Studienaufzeichnungsdaten

Diese Daten verfolgen den Fortschritt der Übermittlung von Studienaufzeichnungen und zusammenfassenden Ergebnissen an ClinicalTrials.gov. Studienaufzeichnungen und gemeldete Ergebnisse werden von der National Library of Medicine (NLM) überprüft, um sicherzustellen, dass sie bestimmten Qualitätskontrollstandards entsprechen, bevor sie auf der öffentlichen Website veröffentlicht werden.

Haupttermine studieren

Studienbeginn (Tatsächlich)

24. Juli 2026

Primärer Abschluss (Geschätzt)

1. Juli 2028

Studienabschluss (Geschätzt)

1. Juli 2028

Studienanmeldedaten

Zuerst eingereicht

25. November 2025

Zuerst eingereicht, das die QC-Kriterien erfüllt hat

28. Januar 2026

Zuerst gepostet (Tatsächlich)

2. Februar 2026

Studienaufzeichnungsaktualisierungen

Letztes Update gepostet (Tatsächlich)

5. Oktober 2026

Letztes eingereichtes Update, das die QC-Kriterien erfüllt

30. September 2026

Zuletzt verifiziert

1. September 2026

Mehr Informationen

Begriffe im Zusammenhang mit dieser Studie

Andere Studien-ID-Nummern

  • SAFE-PFO

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NEIN

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Nein

Studiert ein von der US-amerikanischen FDA reguliertes Geräteprodukt

Nein

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