不同病理形态基质患者冠状动脉CTO再通前后心肌微循环特性
2019年9月24日 更新者:Milan Dobric、University of Belgrade
不同病理形态基质患者冠状动脉慢性完全闭塞再通前后心肌微循环特性
本研究将评估冠状动脉慢性完全闭塞再通后侧支供体动脉心肌微循环参数的变化。
研究概览
详细说明
这项研究将包括患有一根冠状动脉慢性完全闭塞 (CTO) 的患者,他们将接受 CTO 的再通术。
在手术前,将评估心肌活力、缺血、侧支供体血管的功能参数、超声心动图和生活质量。
再通后,将在手术后 24 小时和 6 个月再次评估这些参数。
研究类型
介入性
注册 (预期的)
30
阶段
- 不适用
联系人和位置
本节提供了进行研究的人员的详细联系信息,以及有关进行该研究的地点的信息。
学习地点
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Belgrade、塞尔维亚、11000
- Clinical Centre of Serbia, University of Belgrade
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参与标准
研究人员寻找符合特定描述的人,称为资格标准。这些标准的一些例子是一个人的一般健康状况或先前的治疗。
资格标准
适合学习的年龄
18年 及以上 (成人、年长者)
接受健康志愿者
不
有资格学习的性别
全部
描述
纳入标准:
- 已签署知情同意书参与研究的 18 岁以上患者
- 本地冠状动脉上存在一名 CTO(TIMI 0 流量)
存在尝试对 CTO 进行 PCI 的临床指征(至少存在一项标准):
- 典型稳定型心绞痛的症状
- 闭塞动脉区域存在可诱导的缺血
- 闭塞动脉区域内存在存活的心肌
- 闭塞动脉直径≥2.5mm
排除标准:
- 最近一个月急性冠脉综合征
- 在 12 个月内存在双重抗血小板治疗的禁忌症
- 植入药物洗脱支架的禁忌症
- 自体冠状动脉上存在 2 个或更多 CTO(TIMI 0 流量)
- 冠状动脉严重迂曲或钙化
- 左心室动脉瘤
- 既往冠状动脉湾旁路移植术或任何其他心脏手术
- 既往冠状动脉供血区心肌梗死与 CTO 不同
- 左心室射血分数低于 30%
- 永久性房颤
- 怀孕
- 已知对碘造影剂过敏且药物无法控制的患者
- 不能或不愿配合前来检查的患者
- 预期寿命不到一年
- 出血素质、凝血障碍或输血排斥
学习计划
本节提供研究计划的详细信息,包括研究的设计方式和研究的衡量标准。
研究是如何设计的?
设计细节
- 主要用途:治疗
- 分配:不适用
- 介入模型:单组作业
- 屏蔽:无(打开标签)
武器和干预
参与者组/臂 |
干预/治疗 |
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其他:冠状动脉慢性完全闭塞患者
在 PCI 手术之前,研究人员将对每位患者的心肌活力、侧支血管的功能参数和生活质量进行评估。
手术后 24 小时和 6 个月将重新评估这些参数以及治疗冠状动脉的功能参数。
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冠状动脉慢性完全闭塞的PCI
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研究衡量的是什么?
主要结果指标
结果测量 |
措施说明 |
大体时间 |
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冠脉血流储备
大体时间:六个月
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侧支供体血管冠状动脉血流储备的变化(PCI 后与 PCI 前的值相比)将被视为主要结果测量
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六个月
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次要结果测量
结果测量 |
措施说明 |
大体时间 |
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冠脉血流速度储备
大体时间:六个月
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侧支供体血管的冠状动脉血流速度储备变化(PCI 后与 PCI 前的值相比)与通过心肌灌注的单光子发射计算机断层扫描 (SPECT) 上存活心肌的百分比测量的生存力的相关性。
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六个月
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室壁运动评分指数 (WMSI)
大体时间:六个月
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冠状动脉血流速度储备变化与负荷超声心动图室壁运动评分指数的关系,其中室壁运动节段异常将被分级为:1-运动正常,2-运动功能减退,3-运动不能和4运动障碍,值越高表示越差结果
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六个月
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6 个月时基线稳定性心绞痛问卷 (SAQ) 的变化
大体时间:六个月
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冠状动脉血流速度储备变化与生活质量的关系,由评估心绞痛频率的 19 项西雅图心绞痛问卷测量(有 9 个问题,答案范围从 1 到 6,总分范围从 0 到 100,其中较高的值表示更好的结果),心绞痛稳定性(有 1 个问题,答案范围为 1 到 6,总分范围为 0 到 100,其中较高的值表示更好的结果),心绞痛频率量表(有 2 个问题,答案范围为 1 到5, 总分0-100分, 分值越高结果越好), 治疗满意度(有4个问题1-6分, 总分0-100分, 分值越高结果越好) ), 和疾病感知/QoL(有 3 个问题,答案范围从 1 到 5,总分范围从 0 到 100,其中较高的值表示更好的结果)
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六个月
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合作者和调查者
在这里您可以找到参与这项研究的人员和组织。
调查人员
- 研究主任:Branko D Beleslin, MD, PhD、University of Belgrade
- 研究主任:Miodrag C Ostojic, MD, PhD、University of Belgrade
出版物和有用的链接
负责输入研究信息的人员自愿提供这些出版物。这些可能与研究有关。
一般刊物
- Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MS, Stewart WJ; Chamber Quantification Writing Group; American Society of Echocardiography's Guidelines and Standards Committee; European Association of Echocardiography. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005 Dec;18(12):1440-63. doi: 10.1016/j.echo.2005.10.005. No abstract available.
- TIMI Study Group. The Thrombolysis in Myocardial Infarction (TIMI) trial. Phase I findings. N Engl J Med. 1985 Apr 4;312(14):932-6. doi: 10.1056/NEJM198504043121437. No abstract available.
- Rentrop KP, Cohen M, Blanke H, Phillips RA. Changes in collateral channel filling immediately after controlled coronary artery occlusion by an angioplasty balloon in human subjects. J Am Coll Cardiol. 1985 Mar;5(3):587-92. doi: 10.1016/s0735-1097(85)80380-6.
- Spertus JA, Winder JA, Dewhurst TA, Deyo RA, Prodzinski J, McDonell M, Fihn SD. Development and evaluation of the Seattle Angina Questionnaire: a new functional status measure for coronary artery disease. J Am Coll Cardiol. 1995 Feb;25(2):333-41. doi: 10.1016/0735-1097(94)00397-9.
- Fefer P, Knudtson ML, Cheema AN, Galbraith PD, Osherov AB, Yalonetsky S, Gannot S, Samuel M, Weisbrod M, Bierstone D, Sparkes JD, Wright GA, Strauss BH. Current perspectives on coronary chronic total occlusions: the Canadian Multicenter Chronic Total Occlusions Registry. J Am Coll Cardiol. 2012 Mar 13;59(11):991-7. doi: 10.1016/j.jacc.2011.12.007.
- Christofferson RD, Lehmann KG, Martin GV, Every N, Caldwell JH, Kapadia SR. Effect of chronic total coronary occlusion on treatment strategy. Am J Cardiol. 2005 May 1;95(9):1088-91. doi: 10.1016/j.amjcard.2004.12.065.
- Sianos G, Werner GS, Galassi AR, Papafaklis MI, Escaned J, Hildick-Smith D, Christiansen EH, Gershlick A, Carlino M, Karlas A, Konstantinidis NV, Tomasello SD, Di Mario C, Reifart N; EuroCTO Club. Recanalisation of chronic total coronary occlusions: 2012 consensus document from the EuroCTO club. EuroIntervention. 2012 May 15;8(1):139-45. doi: 10.4244/EIJV8I1A21. No abstract available.
- Werner GS, Bahrmann P, Mutschke O, Emig U, Betge S, Ferrari M, Figulla HR. Determinants of target vessel failure in chronic total coronary occlusions after stent implantation. The influence of collateral function and coronary hemodynamics. J Am Coll Cardiol. 2003 Jul 16;42(2):219-25. doi: 10.1016/s0735-1097(03)00624-7.
- Rathore S, Matsuo H, Terashima M, Kinoshita Y, Kimura M, Tsuchikane E, Nasu K, Ehara M, Asakura Y, Katoh O, Suzuki T. Procedural and in-hospital outcomes after percutaneous coronary intervention for chronic total occlusions of coronary arteries 2002 to 2008: impact of novel guidewire techniques. JACC Cardiovasc Interv. 2009 Jun;2(6):489-97. doi: 10.1016/j.jcin.2009.04.008.
- Saito S. Progress in angioplasty for chronic total occlusions again. Catheter Cardiovasc Interv. 2010 Nov 15;76(6):850-1. doi: 10.1002/ccd.22847. No abstract available.
- Godino C, Sharp AS, Carlino M, Colombo A. Crossing CTOs-the tips, tricks, and specialist kit that can mean the difference between success and failure. Catheter Cardiovasc Interv. 2009 Dec 1;74(7):1019-46. doi: 10.1002/ccd.22161.
- Werner GS, Gitt AK, Zeymer U, Juenger C, Towae F, Wienbergen H, Senges J. Chronic total coronary occlusions in patients with stable angina pectoris: impact on therapy and outcome in present day clinical practice. Clin Res Cardiol. 2009 Jul;98(7):435-41. doi: 10.1007/s00392-009-0013-5. Epub 2009 Mar 18.
- Delacretaz E, Meier B. Therapeutic strategy with total coronary artery occlusions. Am J Cardiol. 1997 Jan 15;79(2):185-7. doi: 10.1016/s0002-9149(96)00710-2.
- Werner GS. The role of coronary collaterals in chronic total occlusions. Curr Cardiol Rev. 2014 Feb;10(1):57-64. doi: 10.2174/1573403x10666140311123814.
- Werner GS, Surber R, Kuethe F, Emig U, Schwarz G, Bahrmann P, Figulla HR. Collaterals and the recovery of left ventricular function after recanalization of a chronic total coronary occlusion. Am Heart J. 2005 Jan;149(1):129-37. doi: 10.1016/j.ahj.2004.04.042.
- Werner GS, Surber R, Ferrari M, Fritzenwanger M, Figulla HR. The functional reserve of collaterals supplying long-term chronic total coronary occlusions in patients without prior myocardial infarction. Eur Heart J. 2006 Oct;27(20):2406-12. doi: 10.1093/eurheartj/ehl270. Epub 2006 Sep 26.
- Werner GS, Fritzenwanger M, Prochnau D, Schwarz G, Ferrari M, Aarnoudse W, Pijls NH, Figulla HR. Determinants of coronary steal in chronic total coronary occlusions donor artery, collateral, and microvascular resistance. J Am Coll Cardiol. 2006 Jul 4;48(1):51-8. doi: 10.1016/j.jacc.2005.11.093. Epub 2006 Jun 12.
- Werner GS, Ferrari M, Heinke S, Kuethe F, Surber R, Richartz BM, Figulla HR. Angiographic assessment of collateral connections in comparison with invasively determined collateral function in chronic coronary occlusions. Circulation. 2003 Apr 22;107(15):1972-7. doi: 10.1161/01.CIR.0000061953.72662.3A. Epub 2003 Mar 24.
- Werner GS, Richartz BM, Gastmann O, Ferrari M, Figulla HR. Immediate changes of collateral function after successful recanalization of chronic total coronary occlusions. Circulation. 2000 Dec 12;102(24):2959-65. doi: 10.1161/01.cir.102.24.2959.
- Werner GS, Emig U, Bahrmann P, Ferrari M, Figulla HR. Recovery of impaired microvascular function in collateral dependent myocardium after recanalisation of a chronic total coronary occlusion. Heart. 2004 Nov;90(11):1303-9. doi: 10.1136/hrt.2003.024620.
- Zimarino M, Ausiello A, Contegiacomo G, Riccardi I, Renda G, Di Iorio C, De Caterina R. Rapid decline of collateral circulation increases susceptibility to myocardial ischemia: the trade-off of successful percutaneous recanalization of chronic total occlusions. J Am Coll Cardiol. 2006 Jul 4;48(1):59-65. doi: 10.1016/j.jacc.2005.12.079. Epub 2006 Jun 12.
- Sachdeva R, Uretsky BF. The effect of CTO recanalization on FFR of the donor artery. Catheter Cardiovasc Interv. 2011 Feb 15;77(3):367-9. doi: 10.1002/ccd.22806.
- Kurisu S, Mitsuba N, Ishibashi K, Kato Y, Dohi Y, Nishioka K, Kihara Y. A pitfall of fractional flow reserve associated with the presence of collateral circulation. Intern Med. 2011;50(22):2811-3. doi: 10.2169/internalmedicine.50.6104. Epub 2011 Nov 15.
- Ladwiniec A, Hoye A. The haemodynamic effects of collateral donation to a chronic total occlusion: Implications for patient management. Int J Cardiol. 2015 Nov 1;198:159-66. doi: 10.1016/j.ijcard.2015.06.174. Epub 2015 Jul 6.
- Ladwiniec A, Cunnington MS, Rossington J, Mather AN, Alahmar A, Oliver RM, Nijjer SS, Davies JE, Thackray S, Alamgir F, Hoye A. Collateral donor artery physiology and the influence of a chronic total occlusion on fractional flow reserve. Circ Cardiovasc Interv. 2015 Apr;8(4):e002219. doi: 10.1161/CIRCINTERVENTIONS.114.002219.
- Pavlovic SV, Sobic-Saranovic DP, Beleslin BD, Ostojic MC, Nedeljkovic MA, Giga VL, Petrasinovic ZR, Artiko VM, Todorovic-Tirnanic MV, Obradovic VB. One-year follow-up of myocardial perfusion and function evaluated by gated SPECT MIBI in patients with earlier myocardial infarction and chronic total occlusion. Nucl Med Commun. 2009 Jan;30(1):68-75. doi: 10.1097/mnm.0b013e32831a40dd.
- Gunning MG, Anagnostopoulos C, Davies G, Knight CJ, Pennell DJ, Fox KM, Pepper J, Underwood SR. Simultaneous assessment of myocardial viability and function for the detection of hibernating myocardium using ECG-gated 99Tcm-tetrofosmin emission tomography: a comparison with 201Tl emission tomography combined with cine magnetic resonance imaging. Nucl Med Commun. 1999 Mar;20(3):209-14. doi: 10.1097/00006231-199903000-00002.
- Germano G, Kiat H, Kavanagh PB, Moriel M, Mazzanti M, Su HT, Van Train KF, Berman DS. Automatic quantification of ejection fraction from gated myocardial perfusion SPECT. J Nucl Med. 1995 Nov;36(11):2138-47.
- Giga V, Dobric M, Beleslin B, Sobic-Saranovic D, Tesic M, Djordjevic-Dikic A, Stepanovic J, Nedeljkovic I, Artiko V, Obradovic V, Seferovic PM, Ostojic M. Estimation of infarct size using transthoracic Doppler echocardiographic measurement of coronary flow reserve in infarct related and reference coronary artery. Int J Cardiol. 2013 Sep 20;168(1):169-75. doi: 10.1016/j.ijcard.2012.09.099. Epub 2012 Oct 8.
- Djordjevic-Dikic A, Beleslin B, Stepanovic J, Giga V, Tesic M, Dobric M, Stojkovic S, Nedeljkovic M, Vukcevic V, Dikic N, Petrasinovic Z, Nedeljkovic I, Tomasevic M, Vujisic-Tesic B, Ostojic M. Prediction of myocardial functional recovery by noninvasive evaluation of Basal and hyperemic coronary flow in patients with previous myocardial infarction. J Am Soc Echocardiogr. 2011 May;24(5):573-81. doi: 10.1016/j.echo.2011.01.004.
- Beleslin B, Ostojic M, Djordjevic-Dikic A, Vukcevic V, Stojkovic S, Nedeljkovic M, Stankovic G, Orlic D, Milic N, Stepanovic J, Giga V, Saponjski J. The value of fractional and coronary flow reserve in predicting myocardial recovery in patients with previous myocardial infarction. Eur Heart J. 2008 Nov;29(21):2617-24. doi: 10.1093/eurheartj/ehn418. Epub 2008 Sep 30.
- Baykan AO, Kalkan GY, Sahin DY, Elbasan Z, Gur M, Seker T, Turkoglu C, Cayli M. Coronary flow velocity reserve in donor artery and myocardial performance index after successful recanalization of chronic total coronary occlusions. J Invasive Cardiol. 2015 Jun;27(6):E75-81.
- Schaper W. Collateral circulation: past and present. Basic Res Cardiol. 2009 Jan;104(1):5-21. doi: 10.1007/s00395-008-0760-x. Epub 2008 Dec 20.
- Matsuo H, Kawase Y. Physiological impact of CTO recanalization assessed by coronary pressure measurement: a case report. Catheter Cardiovasc Interv. 2013 Oct 1;82(4):E459-64. doi: 10.1002/ccd.24842. Epub 2013 Apr 11.
- Iqbal MB, Shah N, Khan M, Wallis W. Reduction in myocardial perfusion territory and its effect on the physiological severity of a coronary stenosis. Circ Cardiovasc Interv. 2010 Feb 1;3(1):89-90. doi: 10.1161/CIRCINTERVENTIONS.109.904193. No abstract available.
- Melikian N, Cuisset T, Hamilos M, De Bruyne B. Fractional flow reserve--the influence of the collateral circulation. Int J Cardiol. 2009 Mar 6;132(3):e109-10. doi: 10.1016/j.ijcard.2007.08.034. Epub 2007 Dec 4.
- Sachdeva R, Agrawal M, Flynn SE, Werner GS, Uretsky BF. Reversal of ischemia of donor artery myocardium after recanalization of a chronic total occlusion. Catheter Cardiovasc Interv. 2013 Oct 1;82(4):E453-8. doi: 10.1002/ccd.25031. Epub 2013 Jul 3.
- Watanabe H, Saito N, Matsuo H, Kawase Y, Watanabe S, Bao B, Yamamoto E, Higami H, Nakatsuma K, Kimura T. In vitro assessment of physiological impact of recipient artery intervention on the contralateral donor artery. Cardiovasc Revasc Med. 2015 Mar;16(2):90-100. doi: 10.1016/j.carrev.2015.01.003. Epub 2015 Jan 30.
- Hesse B, Lindhardt TB, Acampa W, Anagnostopoulos C, Ballinger J, Bax JJ, Edenbrandt L, Flotats A, Germano G, Stopar TG, Franken P, Kelion A, Kjaer A, Le Guludec D, Ljungberg M, Maenhout AF, Marcassa C, Marving J, McKiddie F, Schaefer WM, Stegger L, Underwood R. EANM/ESC guidelines for radionuclide imaging of cardiac function. Eur J Nucl Med Mol Imaging. 2008 Apr;35(4):851-85. doi: 10.1007/s00259-007-0694-9.
- Wahba FF, Bavelaar-Croon CD, Baur LH, Zwinderman AH, van Roosmalen RP, Pauwels EK, van der Wall EE. Detection of residual wall motion after sustained myocardial infarction by gated 99Tcm-tetrofosmin SPECT: a comparison with echocardiography. Nucl Med Commun. 2001 Feb;22(2):175-82. doi: 10.1097/00006231-200102000-00009.
- Acampa W, Cuocolo A, Petretta M, Bruno A, Castellani M, Finzi A, Gerundini P. Tetrofosmin imaging in the detection of myocardial viability in patients with previous myocardial infarction: comparison with sestamibi and Tl-201 scintigraphy. J Nucl Cardiol. 2002 Jan-Feb;9(1):33-40. doi: 10.1067/mnc.2002.118122.
- Dobric M, Beleslin B, Tesic M, Djordjevic Dikic A, Stojkovic S, Giga V, Tomasevic M, Jovanovic I, Petrovic O, Rakocevic J, Boskovic N, Sobic Saranovic D, Stankovic G, Vukcevic V, Orlic D, Simic D, Nedeljkovic MA, Aleksandric S, Juricic S, Ostojic M. Prompt and consistent improvement of coronary flow velocity reserve following successful recanalization of the coronary chronic total occlusion in patients with viable myocardium. Cardiovasc Ultrasound. 2020 Jul 21;18(1):29. doi: 10.1186/s12947-020-00211-4.
研究记录日期
这些日期跟踪向 ClinicalTrials.gov 提交研究记录和摘要结果的进度。研究记录和报告的结果由国家医学图书馆 (NLM) 审查,以确保它们在发布到公共网站之前符合特定的质量控制标准。
研究主要日期
学习开始 (实际的)
2017年3月28日
初级完成 (预期的)
2019年12月15日
研究完成 (预期的)
2020年1月15日
研究注册日期
首次提交
2019年8月4日
首先提交符合 QC 标准的
2019年8月14日
首次发布 (实际的)
2019年8月19日
研究记录更新
最后更新发布 (实际的)
2019年9月25日
上次提交的符合 QC 标准的更新
2019年9月24日
最后验证
2019年9月1日
更多信息
此信息直接从 clinicaltrials.gov 网站检索,没有任何更改。如果您有任何更改、删除或更新研究详细信息的请求,请联系 register@clinicaltrials.gov. clinicaltrials.gov 上实施更改,我们的网站上也会自动更新.
经皮冠状动脉介入治疗的临床试验
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University of Illinois at ChicagoShirley Ryan AbilityLab; Oakland University; Access Living主动,不招人
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University of Wisconsin, MadisonNational Cancer Institute (NCI); Northwestern University主动,不招人