A Standard Carbon Dioxide Flushing Protocol to Reduce Air Embolization During Thoracic Endovascular Aortic Repair (FlushTEVAR)
FlushTEVAR is a non-profit, interventional, randomized, controlled, single-blind, national multicenter study promoted by the University of Bologna and coordinated by the Vascular Surgery Unit of IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, under the direction of Prof. Mauro Gargiulo, who also serves as Principal Investigator. The study aims to develop and evaluate a pre-implant thoracic endograft flushing technique using carbon dioxide (CO₂) to reduce periprocedural embolic events and cerebral infarctions in patients undergoing Thoracic Endovascular Aortic Repair (TEVAR).
TEVAR is currently the treatment of choice for acute aortic syndromes and aneurysms involving the descending thoracic aorta. Despite its widespread use, TEVAR remains associated with significant neurological complications, with an incidence ranging from 3% to 8% in standard procedures and reaching up to 16% in more complex endovascular interventions. Cerebral embolization caused by solid and gaseous particles is considered the main cause of perioperative stroke and silent brain infarction (SBI), the latter being defined as ischemic brain injury detected by neuroradiological imaging in the absence of immediate clinical symptoms. During TEVAR, approximately 90% of microembolic signals detected in the middle cerebral artery are caused by gaseous emboli, with the highest number occurring during endograft deployment. This phenomenon is associated with the manufacturing and sterilization processes of endografts, during which gas microparticles become trapped between the endograft and its delivery system and are subsequently released into the bloodstream when the device is deployed at the intended aortic site.
The primary objective of the study is to assess the difference in the incidence of major neurological events, including stroke and transient ischemic attack (TIA), as well as silent brain infarctions, between patients whose endografts undergo a standardized pre-implant flushing protocol with CO₂ followed by conventional saline flushing, and patients receiving standard saline flushing alone. Major neurological events will be assessed clinically, while silent brain infarctions will be evaluated using study-specific diffusion-weighted magnetic resonance imaging (DW-MRI) of the brain performed within 72 hours after the procedure.
A total of 90 patients will be enrolled across four participating centers and randomized in a 1:1 ratio after providing informed consent. Forty-five patients will be allocated to the experimental arm and treated with CO₂ flushing before the standard saline flushing procedure during TEVAR, while forty-five patients will be allocated to the control arm and will receive standard saline flushing only.
Eligible patients must be at least 18 years of age and present with type B acute aortic syndrome in the acute, subacute, or chronic phase, or thoracic and thoracoabdominal aneurysms with Crawford extent I, II, III, or IV. Written informed consent is required for participation. Patients will be excluded if the procedure is performed using CO₂ angiography, if endografts without a sheath are used, if emergency endovascular treatment is required, if they have experienced a stroke or TIA within the previous six months, if the proximal sealing zone is 0 or 1, if any contraindication to DW-MRI is present, or in cases of pregnancy or breastfeeding.
At study completion, the two treatment groups will be compared on the basis of diffusion-weighted brain MRI findings. The primary endpoint is the number of silent brain infarctions and the determination of whether a statistically significant difference exists between the CO₂ flushing group and the saline flushing group. The safety of the procedure will be evaluated through both technical and clinical success. The planned study duration is three years, and postoperative rates of SBI and TIA/stroke will be compared between groups using Fisher's and Pearson's chi-square tests.
연구 개요
상태
상태
정황
정황
개입 / 치료
개입 / 치료
연구 유형
연구 유형
등록 (추정된)
등록
단계
단계
- 해당 없음
연락처 및 위치
연구 연락처
연구 연락처
- 이름: Mauro Gargiulo, MD
- 전화번호: +39 0512144252
- 이메일: mauro.gargiulo2@unibo.it
연구 연락처 백업
- 이름: Chiara Mascoli, MD
- 전화번호: +39 0512144278
- 이메일: chiara.mascoli@aosp.bo.it
연구 장소
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Italy
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Bologna, Italy, 이탈리아, 40138
- 모병
- IRCCS Azienda Ospedaliero-Universitaria di Bologna
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수석 연구원:
- Mauro Gargiulo, MD
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연락하다:
- Mauro Gargiulo, MD
- 전화번호: +39 0512144252
- 이메일: mauro.gargiulo2@unibo.it
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연락하다:
- Mascoli Chiara, MD
- 전화번호: +39 0512144278
- 이메일: chiara.mascoli@aosp.bo.it
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부수사관:
- Chiara Mascoli, MD
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부수사관:
- Stefania Caputo, MD
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Brescia, Italy, 이탈리아, 25123
- 아직 모집하지 않음
- A.S.S.T. Spedali Civili di Brescia
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연락하다:
- Stefano Bonardelli, MD
- 전화번호: +39 3332929425
- 이메일: stefano.bonardelli@unibs.it
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수석 연구원:
- Stefano Bonardelli, MD
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Genova, Italy, 이탈리아, 16132
- 아직 모집하지 않음
- IRCCS Policlinico San Martino di Genova
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수석 연구원:
- Giovanni Pratesi, MD
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연락하다:
- Giovanni Pratesi, MD
- 이메일: Giovanni.Pratesi@unige.it
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Padova, Italy, 이탈리아, 35128
- 아직 모집하지 않음
- Azienda Ospedaliero-Universitaria di Padova
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연락하다:
- Franco Grego, MD
- 전화번호: +39 0498212638
- 이메일: franco.grego@unipd.it
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수석 연구원:
- Franco Grego, MD
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참여기준
자격 기준
자격 기준
공부할 수 있는 나이
- 성인
- 고령자
건강한 자원 봉사자를 받아들입니다
설명
Inclusion Criteria:
- Age is at least 18 years
- Present with type B acute aortic syndrome in the acute, subacute, or chronic phase
- Thoracic and thoracoabdominal aneurysms with Crawford extent I, II, III, or IV
- Written informed consent
Exclusion Criteria:
- Procedure performed using CO₂ angiography
- Endografts without a sheath is used
- Emergency endovascular treatment required
- Patient has experienced a stroke or TIA within the previous six months
- Proximal sealing zone is 0 or 1
- Any contraindication to DW-MRI
- Pregnancy or breastfeeding
공부 계획
연구는 어떻게 설계됩니까?
디자인 세부사항
- 주 목적: 방지
- 할당: 무작위
- 중재 모델: 병렬 할당
- 마스킹: 하나의
팔의 수
무기와 개입
참가자 그룹 / 팔참가자 그룹 / 팔 |
개입 / 치료개입 / 치료 |
|---|---|
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실험적: CO₂ flushing before the standard saline flushing procedure during TEVAR
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The CO2 flushing technique is conducted using an automated injector with the application of standard injection volume and pressure.
Specifically, the endoprosthesis will be flushed from the side port of the delivery system with 3 CO2 injections at 750 mmHg of pressure and 100 cc of volume.
Following the IFU, the endograft delivery system will be flushed with 60 ml of saline solution at 0.9%.
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활성 비교기: only standard saline flushing procedure during TEVAR
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Following the IFU, the endograft delivery system will be flushed with 60 ml of saline solution at 0.9%.
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연구는 무엇을 측정합니까?
주요 결과 측정
주요 결과 측정
결과 측정 |
측정값 설명 |
기간 |
|---|---|---|
|
Assess the number and location of SBI using study-specific diffusion-weighted magnetic resonance imaging (DW-MRI) and determine if there is a statistically significant difference of SBI number in the "CO2 arm", compared to the "saline solution arm".
기간: Up to 72 hours after endovascular repair
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The primary objective of the study is to assess the difference in terms of incidence (number) of ischaemic cerebral lesions, detected by DW-MRI after TEVAR, between patients whose endografts undergo a standardized pre-implant flushing protocol with CO₂ followed by conventional saline flushing, and patients receiving standard saline flushing alone,
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Up to 72 hours after endovascular repair
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2차 결과 측정
2차 결과 측정
결과 측정 |
측정값 설명 |
기간 |
|---|---|---|
|
Technical and clinical success
기간: Peri-operatively
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Technical success: successfull endograft deployment, patency, absence of type I-III endoleak, retrograde dissections. Clinical success: absence of major stroke, death, paraplegia, major bleeding, acute kidney injury. |
Peri-operatively
|
공동 작업자 및 조사자
협력자
협력자
수사관
수사관
- 수석 연구원: Mauro Gargiulo, MD, University of Bologna
연구 기록 날짜
연구 주요 날짜
연구 시작 (실제)
연구 시작
기본 완료 (추정된)
기본 완료
연구 완료 (추정된)
연구 완료
연구 등록 날짜
최초 제출
최초 제출
QC 기준을 충족하는 최초 제출
QC 기준을 충족하는 최초 제출
처음 게시됨 (실제)
처음 게시됨
연구 기록 업데이트
마지막 업데이트 게시됨 (실제)
마지막 업데이트 게시됨
QC 기준을 충족하는 마지막 업데이트 제출
QC 기준을 충족하는 마지막 업데이트 제출
마지막으로 확인됨
마지막으로 확인됨
추가 정보
이 연구와 관련된 용어
추가 관련 MeSH 약관
기타 연구 ID 번호
기타 연구 ID 번호
- FlushTEVAR
- Funding for a non-profit trial (기타 보조금/기금 번호: Angiodroid S.P.A.)
약물 및 장치 정보, 연구 문서
미국 FDA 규제 의약품 연구
미국 FDA 규제 기기 제품 연구
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