用 OCT 量化冲击波引起的钙化斑块衰减 (SCALPO)
2023年7月25日 更新者:Prof. Giuseppe Sangiorgi、University of Rome Tor Vergata
这项观察性、前瞻性、多中心研究的目的是通过 OCT 采集的图像,探讨血管内碎石术对冠状动脉钙化对导致显着狭窄、适合接受 PCI 的患者的局部作用。
它旨在回答的主要问题是冲击波系统降低血管壁感兴趣区域 (ROI) 中钙密度的能力。
研究概览
详细说明
有钙化病变的冠状动脉将接受血管内碎石术(IVL)治疗; OCT采集将在IVL治疗前、IVL治疗后和支架植入后进行。
所有 OCT 帧都将上传到图像处理和分析程序 ImageJ(美国国立卫生研究院)。
将选择 ROI 作为钙所在图像的一部分。
将使用 IVL 前后 ROI 中像素密度的频率直方图进行图像分析,作为钙密度的测量。
IVL 之前 ROI 的平均像素密度将与 IVL 后 ROI 的平均像素密度进行比较,测量增量像素密度。
研究类型
观察性的
注册 (估计的)
30
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。
学习联系方式
- 姓名:Giuseppe M Sangiorgi, Professor
- 电话号码:0620904009
- 邮箱:gsangiorgi@gmail.com
学习地点
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Rome
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Roma、Rome、意大利、00133
- 招聘中
- University of Rome Tor Vergata - Policlinico
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接触:
- Giuseppe M Sangiorgi, Professor
- 电话号码:0620904009
- 邮箱:gsangiorgi@gmail.com
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接触:
- Gianluca Massaro, Cardiologist
- 邮箱:gianluca88massaro@gmail.com
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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
- 成人
- 年长者
接受健康志愿者
不
取样方法
非概率样本
研究人群
导管插入实验室中接受冠状动脉造影的所有患者都可能被选中。
描述
纳入标准:
- 患有适合 PCI 的固有冠状动脉疾病(包括稳定或不稳定心绞痛和无症状缺血)的受试者
- 入组前测量的左心室射血分数 (LVEF) ≥35%
- eGFR ≥45 毫升/分钟(Cockroft-Gault,MDRD)
- 手术前 24 小时内肌钙蛋白必须小于或等于实验室正常值上限,或者如果肌钙蛋白升高,伴随的 CK 必须正常
- 能够耐受双重抗血小板治疗(即 阿司匹林和氯吡格雷、普拉格雷或替格瑞洛)至少 6 个月(对于未接受口服抗凝治疗的患者)并终身单一抗血小板治疗
- 目标病变必须是以前未接受过任何介入手术治疗的新发冠状动脉病变
- LAD、RCA 或 LCX(或其分支)的单一从头靶病变狭窄,狭窄≥70%且<100%,或狭窄≥50%且<70%(目视评估),并通过阳性压力测试显示缺血证据,或血流储备分数值 ≤0.80,或 iFR <0.89 或 IVUS 或 OCT 最小管腔面积 ≤4.0 mm²
- 参考容器的直径必须为 2.5 毫米 - 4.0 毫米,长度 ≤ 30 毫米
- 通过血管造影评估病变部位的钙化证据,在注射对比剂之前,在没有心脏运动的情况下,在至少一个位置涉及动脉壁两侧,并且钙的总长度至少为 15 毫米,并且部分延伸到目标病变,或通过 IVUS 或 OCT,至少 1 个横截面存在 ≥270 度的钙
- 对每个靶血管的单一病变进行有计划的治疗
- 能够将 0.014" 导丝穿过病变部位
- 目标容器的基线必须具有 TIMI 流量 3
排除标准:
- 左心室射血分数 (LVEF) <35%
- 受试者怀孕或哺乳
- eGFR <45 ml/min(Cockroft-Gault,MDRD)或慢性透析
- 未经治疗的术前血红蛋白 <9 g/dL 或在必要时拒绝输血的意图
- 患者的血小板计数 <100,000 个细胞/mm3 或 >750,000 个细胞/mm3
- 患者已知对方案所需药物(氯吡格雷、噻吩并吡啶、阿司匹林、造影剂)过敏,且无法充分进行术前用药
- 未控制的糖尿病定义为空腹高血糖 >200 mg/dL 或 HbA1c 大于或等于 10%
- 患者在过去 6 个月内曾发生过脑血管意外 (CVA) 或短暂性脑缺血发作 (TIA),或存在任何可能导致不遵守方案的永久性神经系统缺陷
- 患者患有活动性消化性溃疡或活动性胃肠道 (GI) 出血
- 患者有凝血障碍病史
- 受试者正在参与另一项涉及尚未达到主要终点的研究药物(药物、生物制品或医疗器械)的研究
- 预期寿命不足1年的受试者
- 受试者拒绝或不是紧急冠状动脉搭桥术 (CABG) 手术的候选人
- 计划使用斑块旋切术、刻划或切割球囊或碎石术以外的任何研究设备
- 过去一年内在目标血管内植入支架或在距离目标病变10毫米以内的支架
- 目标血管中明确或可能存在血栓(通过血管造影或血管内成像)
- 基线时或导丝通过后目标血管中存在解剖的血管造影证据
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
队列和干预
团体/队列 |
干预/治疗 |
---|---|
患有严重钙化性冠状动脉狭窄且适合接受 PCI 的患者
冠状动脉钙化导致显着狭窄的患者将接受基础 OCT 采集。
应用血管内碎石术 (IVL) 后,将进行第二次 OCT 采集。
将比较 IVL 之前和 IVL 后血管 ROI 的平均钙密度。
第二次 OCT 采集后将进行支架植入。
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OCT 采集在基线处进行。
然后 IVL 导管将通过导丝穿过病变部位。
根据协议,不允许进行斑块旋切术或切割/刻划球囊。
当存在残余狭窄时,IVL 手术被认为是成功的
其他名称:
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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 |
---|---|---|
碎石治疗后血管感兴趣区域 (ROI) 钙密度降低
大体时间:五到十分钟
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钙密度测量为 OCT 采集时碎石前后钙化病变图像之间的像素密度差值
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五到十分钟
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次要结果测量
结果测量 |
措施说明 |
大体时间 |
---|---|---|
减少冠状动脉内碎石术后支架贴壁不良
大体时间:支架植入后五分钟
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支架贴壁不良测量为支架植入后通过 OCT 获得的病变框架中支柱的近腔表面与动脉壁的腔表面之间的距离。
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支架植入后五分钟
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初次手术后急性血管夹层和急性支架血栓或亚急性血管血栓的发生率
大体时间:一、六个月
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安全终点
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一、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
- 首席研究员:Giuseppe M Sangiorgi, Professor、University of Rome Tor Vergata
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
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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)
2022年2月21日
初级完成 (估计的)
2023年12月31日
研究完成 (估计的)
2024年6月30日
研究注册日期
首次提交
2023年7月25日
首先提交符合 QC 标准的
2023年7月25日
首次发布 (实际的)
2023年8月3日
研究记录更新
最后更新发布 (实际的)
2023年8月3日
上次提交的符合 QC 标准的更新
2023年7月25日
最后验证
2023年7月1日
更多信息
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