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Coronary Artery DiseasePhase 3OCTEVERESTNCT01146080

Optical Coherence Tomography for EVERolimus Eluting STent

A Phase 3 study testing Promus Element and Promus in people with Coronary Artery Disease, run by A.O. Ospedale Papa Giovanni XXIII at 1 site in Italy.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Compared with bare metal stents (BMS), both paclitaxel-eluting stents (PES) and sirolimus-eluting stents (SES) significantly reduce angiographic restenosis and the need for repeat revascularization in coronary arteries across a broad range of patient and lesion types. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Coronary Artery Disease
What is being tested?
Promus Element and Promus
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
42 participants
Where
1 siteItaly
Study dates
Feb 2010to Oct 2015
Phase
Phase 3
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patient is ≥ 18 years of age
  • Patient is eligible for percutaneous coronary intervention (PCI)
  • Patient has documented stable angina pectoris (Canadian Cardiovascular Society [CCS] Classification 1, 2, 3, or 4) or documented silent ischemia; or unstable angina pectoris (Braunwald Class IB-C, IIB-C, or IIIB-C)
  • Patient demonstrates a left ventricular ejection fraction (LVEF) of ≥ 40% as measured prior to enrollment
  • Patient understands and agrees to comply with all specified study requirements and provides written Informed Consent to this effect.
  • Angiographic Inclusion Criteria
Show all 9Show fewer
  • Target lesion must be located in a native coronary artery with a visually estimated reference vessel diameter (RVD) ≥ 2.50 mm and ≤ 3,75 mm.
  • Target lesion length must measure (by visual estimate) ≤ 24 mm.
  • Target lesion must be in a major coronary artery or branch with visually estimated stenosis ≥ 50% and <100% with TIMI flow >1.

Who cannot join

  • General Exclusion Criteria
  • The patient has a life expectancy of less than 24 months due to another medical condition
  • Patient has a history of hypersensitivity to everolimus or paclitaxel or structurally related compounds
  • Patient exhibits cardiogenic shock (systolic pressure < 80mm Hg and PCWP > 20mm Hg or cardiac index <1.8 liters/minute/m2 or intra-aortic balloon pump or intravenous inotropes are needed to maintain a systolic pressure>80 mm Hg) for any time within 24 hours prior to index procedure
  • Patient demonstrates evidence of acute or chronic renal dysfunction (serum creatinine > 2.0 mg/dl or 177 μmol/l)
  • Planned cardiac surgery procedure ≤ 6 months post-index procedure
Show all 30Show fewer
  • Patient demonstrates evidence of a acute myocardial infarction (eg. STEMI or enzyme elevation CK > 2X local laboratory's ULN unless CK-MB is < 2X ULN) 7)
  • Cerebrovascular accident (CVA) including stroke or TIA within previous 3 months
  • Patient demonstrates evidence of leukopenia (leukocyte count < 3.5 X 109/liter)
  • Patient demonstrates evidence of thrombocytopenia (platelet count < 100,000/mm3) or thrombocytosis (>750,000/mm3)
  • Patient is contraindicated to Aspirin (successful prior desensitization to Aspirin is not an exclusion), clopidogrel, or ticlopidine
  • Patient is currently on warfarin, or possibility of treatment with warfarin during the following 6 months post index procedure
  • Patient has been treated with paclitaxel, everolimus or other chemotherapeutic agents within 12-months prior to planned index procedure
  • Anticipated treatment with paclitaxel, everolimus or oral rapamycin during any period in the 6-months after the index procedure
  • Known allergy to stainless steel
  • Female or male with known intention to procreate within 3 months after the index procedure (due to the exposure to paclitaxel and unknown affect it may have on the fetus)
  • Female of childbearing potential with a positive pregnancy test within 7 days before the index procedure, or lactating, or intends to become pregnant during the 9 months post index procedure
  • Patient that in the opinion of the investigator is not clinically appropriate for OCT evaluation.
  • Angiographic Exclusion Criteria
  • Evidence of thrombus of the study vessel, based on angiography or IVUS
  • Study lesion is totally occluded (TIMI flow ≤ 1) either at baseline or before predilatation
  • Study lesion, or the study vessel proximal to the study lesion is moderately or severely calcified, by visual estimate
  • Study lesion is ostial in location (within 5.0 mm of vessel origin)
  • Study lesion involving arterial segments with highly tortuous anatomy or where lesion is located within or distal to a >60 degree bend in the vessel
  • Study lesion involves a bifurcation with a diseased (>50% stenotic) branch - Left main coronary artery disease (stenosis >50%) whether protected or unprotected
  • Target lesion length > 24 mm, based on visual estimate by operator
  • Target vessel diameter > 3.75 mm, based on visual estimate by operator
  • Target vessel diameter < 2.5 mm based on visual estimate by operator
  • Pre-treatment of the target lesion (excluding predilation) with another interventional device.
  • Target lesion is restenotic from previous intervention

Trial locations and contacts

1 site in 1 country.

Italy1 site
  • Cardiovascular Department Ospedali Riuniti di Bergamo

    Bergamo, BG, 24128

Other trials in Italy

About this study

Official title: Optical Coherence Tomography for EVERolimus Eluting STent (OCTEVEREST)

Compared with bare metal stents (BMS), both paclitaxel-eluting stents (PES) and sirolimus-eluting stents (SES) significantly reduce angiographic restenosis and the need for repeat revascularization in coronary arteries across a broad range of patient and lesion types. However the increased risk of very late stent thrombosis represents a major concern for patients treated with both PES and SES. Optical coherence tomography (OCT), a new imaging technique based on the back reflection of near infrared light, enables real-time, full tomographic, in-vivo visualization of coronary vessel microstructure. Struts coverage and vessel response of drug eluting stent (DES) compared to BMS are the most immediate clinical applications of OCT. Thickness of coverage and strut apposition can be quantified at micron-scale level with a resolution 10-30 times higher than conventional intravascular ultrasound (IVUS). The objective of this study OCTEVEREST (Optical Coherence Tomography for EVERolimus Eluting STent) is to evaluate the long term struts coverage and vessel wall response (abnormal intraluminal defects, strut malapposition, vessel expansions) to the PROMUS™ Everolimus Eluting Stent compared to PROMUS ELEMENT™ Everolimus Eluting Stent implanted for the treatment of stenosis in native coronaries. To investigate the completeness of struts coverage as well as the proportion of malapposed struts and the neointima characteristics, high resolution (~ 10 µ axial) intracoronary Optical Coherence Tomography (OCT) and intravascular coronary ultrasound (IVUS) will be used.

Read the detailed description

This is a prospective single center clinical study designed to evaluate the long term struts coverage and vessel wall response (abnormal intraluminal defects, strut malapposition, vessel espansions) to the PROMUS™ Everolimus Eluting Stent compared to PROMUS ELEMENT ™ Everolimus Eluting Stent implanted for the treatment of stenosis in native coronaries. The difference between the two stents is in the stent platform made of a novel alloy of chromium-platinum with low strut thickness and stent crossing profile (0.042" [1.062 mm]) for PROMUS ELEMENT ™ Everolimus Eluting Stent. To investigate the completeness of struts coverage as well as the proportion of malapposed struts and the neointima characteristics, high resolution (~ 10 µ axial) intracoronary Optical Coherence Tomography (OCT) and intravascular coronary ultrasound (IVUS) will be used. The study will be carried out at Ospedali Riuniti di Bergamo, Italy with a target enrollment of consecutive 21 patients for each group receiving one or two Everolimus Eluting stents. All patients enrolled in the study will be followed to 12 months post stent placement.

PLATFORM TO BE USED PROMUS™ everolimus eluting stent. Stent sizes: 2.5 to 3.5 mm, 12 - 15 - 20 - 23 - 28 mm in lengths (according to product specifications).

PROMUS ELEMENT ™ Everolimus Eluting Stent. Stent sizes: 2.5 to 3.5 mm, 12 - 15 -20 - 23 - 28 mm in lengths (according to product specifications).

Patients presenting with a coronary artery lesion who are considered candidates for percutaneous coronary intervention and stent placement are eligible for the OCTEVEREST (Optical Coherence Tomography for EVERolimus Eluting STent)trial. Patients may have a second study lesion that can be treated with a second PROMUS™ Stent or PROMUS ELEMENT ™ Everolimus Eluting Stent.

Patients who do not meet all inclusion/exclusion criteria will not be enrolled or followed in the study. All patients who are candidates for the OCTEVEREST trial and undergo placement of the device must be consented prior to any data collection by a member of the institution's research team. All patients enrolled will be evaluated according to this protocol, regardless of sequence of treatment that ensues. More than one study lesion in different epicardial vessels may be treated in the same stage procedure. Actual study enrollment occurs following successful pre-dilatation of the study vessel, when the study device is introduced into the body. The target lesion must be able to be covered with a single stent. For diffuse lesions the total lesion length will be measured from the proximal shoulder of the most proximal lesion to the distal shoulder of the most distal lesion and should not exceed 24 mm. At 6 month follow-up, the entire stented region will be used to determine the mean lumen diameter and the percent diameter stenosis.

Optical coherence tomography (OCT) will be performed baseline and at 6 month follow up. Study site is requested to use the same OCT equipment for both procedures. The OCT procedure will be conducted according to Optical Coherence Tomography as specified by the Protocol. Optical Coherence Tomography images will be acquired at 15-30 frames per second (500 angular pixels x 250 radial pixels), from a 0.006" micro-optic core, 0.014" image wire, displayed with an inverse gray-scale lookup table, and digitally archived. The optical source used in this study has a center wavelength of 1310 nm and a bandwidth of 70 nm, providing an axial resolution of (10-12 μm in tissue with a tissue penetration of 2 mm). The transverse resolution, determined by the spot size of the sample arm beam, is 25 μm. OCT images will be analyzed by an independent Corelab (Cardialysis, Cleveland) expert in high resolution OCT analysis. An automatic analysis with novel dedicated software will be used for quantitative assessment. Interactive revision of contour appropriateness will be performed by experienced readers. In a blind fashion 10% of all sections will be re-evaluated to estimate the measurement variability (k value). The existence of malapposition will be assessed.

Angiography Angiography will be performed at baseline prior to stent placement, after stent placement, and at 6 month follow up. The Angiography procedure will be conducted according to Angiographic Core Laboratory procedure .A baseline angiography of the involved vessel will be performed in at least two near orthogonal views. Visual angiographic assessment will be used to determine if the lesion meets angiographic entry criteria. The study lesion must be free of foreshortening or vessel overlap. If angiography demonstrates that the target lesion meets study eligibility criteria, then the patient may be enrolled in the study.

Intravascular Ultrasound IVUS will be performed at the time of index procedure and at 6 month follow up. IVUS will initially be performed after successful, uncomplicated stent implantation (diameter stenosis <10%, TIMI-3 flow). Study site IS requested to use the same IVUS equipment for both procedures. IVUS will be performed on all patients according to IVUS Core. Laboratory Acquisition Protocol. Imaging will be performed with a 40 MHz Atlantis catheter (Boston Scientific), after 50- 200 mcg of intracoronary nitroglycerin. Automated motorized pullback at 0.5 mm/sec will utilized during all IVUS runs (Hi-Lab Boston Scientific). Imaging will include the edges at least 5 mm proximal and distal to the stent. The transducer will be advanced at least 10 mm distal to the distal edge of the stent(s), and a continuous, uninterrupted imaging run performed to a point at least 10mm proximal to the proximal edge of the stent(s). All IVUS studies will be archived for subsequent CoreLab analysis in DICOM format. IVUS analysis will include measurements of external elastic membrane (EEM), stent, and lumen cross-sectional areas and volumes according to the Standards for the Acquisition, Measurement, and Reporting of Intravascular Ultrasound Studies. In addition, qualitative analysis (incomplete apposition, dissections) will also be performed according to the same standards document.

Being tested
Promus Element, Promus
Keywords
drug eluting stent, everolimus eluting stent, optical coherence tomography, intravascular ultrasound
Medical subject headings
Coronary Artery Disease

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Promus ElementDevice

    Promus Element implanted to treat coronary artery lesions.

  • PromusDevice

    Promus stent implanted to treat coronary artery lesions

Study groups in NCT01146080
Study groupRoleWhat they receive
Promus ElementExperimental21 consecutive patients with Promus Element implanted to treat coronary artery lesion
Receives: Device: Promus Element
PromusActive comparator21 consecutive patients with Promus stent implanted to treat coronary artery lesions
Receives: Device: Promus

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Proportion of stent struts uncovered at 6 months as measured by OCT

    The proportion of stent struts uncovered by endothelial tissue will be determined by measuring the number of exposed struts, defined as a measured neointimal hyperplasia (NIH) thickness less than 10 μm, at 0.5 mm cross section analysis, divided by the total number of stent struts. This analysis shall be performed using a dedicated software, as assessed by OCT core lab at 6 month follow up.

    Measured: 6 months

Secondary outcomes (6)
  1. Major Adverse Cardiac Events (MACE)

    including any cardiac death, myocardial infarction (Q wave and non Q wave MI) and target vessel revascularization at 6 month follow-up. All specific components of MACE will be summarized. MACE shall be assessed at discharge (or within 7 days post index procedure, whichever comes first), 1, 6, 12 and 24 month follow up

    Measured: 1,6,12,24 months

  2. Stent Thrombosis rate through 24 months

    based on the Academic Research Consortium - ARC definitions (definite, probable or possible). Stent thrombosis shall be considered subacute stent thrombosis if it occurs < 30 days after stenting; late stent thrombosis if it occurs > 30 days and ≤ 1 year after index stenting and very late stent thrombosis if it occurs > 1 year and ≤ 2 years after index procedure.

    Measured: 24 months

  3. Target Lesion Revascularization

    Any repeat revascularization procedure (percutaneous or surgical) of the original target lesion site, which includes the stented plus edge (typically 5 mm proximal and distal to the stent) segments

    Measured: 24 months

  4. QCA parameters:

    mean lumen diameter, acute gain, late loss through 6 months, and binary restenosis (≥ 50% diameter stenosis) rate at 6 months follow-up as determined by Quantitative Coronary Angiography

    Measured: 6 months

  5. Additional OCT parameters

    Neointimal thickness at every 0.5 mm sections- mean and max, proportion of Low Intensity Parastrut Material, number and size of abnormal intraluminal masses related to malapposed struts, neointima characterization at 6 months follow-up

    Measured: 6 months

  6. IVUS parameters

    including neointimal area volume, stent and area volumes, stent apposition, and percent net volume obstruction at 6 months as determined by intravascular ultrasound

    Measured: 6 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted17 Jun 2010 (estimated)
  2. Study startFeb 2010
  3. Primary completionOct 2015
  4. Study completionOct 2015

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Non-randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
42 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01146080
Sponsor's protocol ID
BG-001-09
Acronym
OCTEVEREST
Status last verified
Oct 2015
First submitted
16 Jun 2010
Last updated
16 Oct 2015
Results posted
No
Data monitoring committee
Yes

Publications

  • Guagliumi G, Capodanno D, Ikejima H, Bezerra HG, Sirbu V, Musumeci G, Fiocca L, Lortkipanidze N, Vassileva A, Tahara S, Valsecchi O, Costa MA. Impact of different stent alloys on human vascular response to everolimus-eluting stent: an optical coherence tomography study: the OCTEVEREST. Catheter Cardiovasc Interv. 2013 Feb;81(3):510-8. doi: 10.1002/ccd.24374. Epub 2012 May 2.

    PubMed 22431208

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Promus Element and Promus in people with Coronary Artery Disease, run by A.O. Ospedale Papa Giovanni XXIII at 1 site in Italy.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 9 inclusion and 30 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 16 Oct 2015. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Italy. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Proportion of stent struts uncovered at 6 months as measured by OCT (time frame: 6 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT01146080, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 16 Oct 2015.

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