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Coronary Artery DiseaseSHEAR-STENTNCT02098876

Wall Shear Stress and Neointimal Healing Following PCI in Angulated Coronary Vessels

A study testing Resolute Integrity Zotarolimus eluting stent, Xience Xpedition everolimus eluting stent and Optical Coherence Tomography (OCT) in people with Coronary Artery Disease, run by Emory University at 10 sites in 7 countries.

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

Stents are metallic tubular supports placed inside a blood vessel to relieve an obstruction and restore blood flow to the heart muscle. Stents could also be coated with a drug (drug-eluting stents - DES) that improves local healing and inhibits growth of scar tissue within the vessel that otherwise could lead to… Read more about this study

Who is it for?
Ages 30 to 80 years
Conditions the study is for
Coronary Artery Disease
What is being tested?
Resolute Integrity Zotarolimus eluting stent, Xience Xpedition everolimus eluting stent and Optical Coherence Tomography (OCT)
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
86 participants
Where
10 sitesin 7 countries
Study dates
May 2014to Dec 2020
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

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 30 to 80 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patient must be 30 to 80 years old
  • Severe coronary lesion in a vessel with ≥ 30-degree angulation requiring percutaneous coronary intervention (PCI)
  • Lesion treatable by a single Resolute Integrity or Onyx Abbott Xience Xpedition or Sierra coronary drug-eluting stent.
  • Patients with stable ischemic heart disease or acute coronary syndrome undergoing clinically PCI.

Who cannot join

  • Inability to provide informed consent prior to randomization
  • Anatomy requiring coronary artery bypass surgery (CABG)
  • History of prior CABG in the territory of the vessel being considered for PCI
  • Heavily calcified lesion requiring rotablation or other debulking or scoring device for successful stent deployment
  • Large thrombus burden on recent angiography
  • Previously stented vessels
Show all 16Show fewer
  • Ostial lesions: lesion located within 5mm of the origin of the left anterior descending artery (LAD), left circumflex artery (LCx), or Right coronary artery (RCA)
  • Lesions at bifurcations and those that occlude side branches >2.5mm
  • Recent (<72 hours) ST-elevation myocardial infarction (STEMI).
  • Planned surgical procedures in the subsequent 12 months
  • History of hypersensitivity or contraindication to device materials and their degradants, everolimus, zotarolimus, cobalt, chromium, nickel, platinum, tungsten, acrylic, and fluoropolymers
  • History of any solid organ transplantation or subject is on a waiting list for any solid organ transplant
  • Left ventricular ejection fraction < 30%
  • Known allergies to clinically utilized anti-thrombotic or anti-platelet agents
  • Unable to tolerate long term dual antiplatelet therapy
  • Pregnancy or lactation

Trial locations and contacts

10 sites in 7 countries.

10 sites in 7 countries

South Korea3 sites
  • Seoul National University College of Medicine

    Seoul, 03080

  • Samsung Medical Center, Sungkyunkwan University School of Medicine Division of Cardiology

    Seoul, 06351

  • Ulsan University Hospital University of Ulsan College of Medicine

    Ulsan, 44033

Other trials in South Korea

Japan2 sites
  • Kobe University Graduate School of Medicine

    Hyōgo, 650-0017

  • Wakayama Medical University Department of Cardiovascular Medicine

    Wakayama, 641-8509

Other trials in Japan

United States1 site
  • Emory University

    Atlanta, Georgia, 30605

Other trials in United States

China1 site
  • Nanjing Medical University, Nanjing Heart Center

    Nanjing, 310006

Other trials in China

Latvia1 site
  • Latvian Society of Cardiology Pauls Stradins Clinical University Hospital

    Riga, 1002

Other trials in Latvia

Serbia1 site
  • University Clinical Center of Serbia

    Belgrade, 11000

Other trials in Serbia

Spain1 site
  • Hospital Clinico San Carlos, Universidad Complutense de Madrid

    Madrid, 28040

Other trials in Spain

About this study

Official title: Evaluation of WSS and Neointimal Healing Following Percutaneous Coronary Intervention of Angulated Vessels With Resolute® Integrity Zotarolimus Eluting Coronary Stent Compared to XIENCE Xpedition® Everolimus Eluting Coronary Stent

Stents are metallic tubular supports placed inside a blood vessel to relieve an obstruction and restore blood flow to the heart muscle. Stents could also be coated with a drug (drug-eluting stents - DES) that improves local healing and inhibits growth of scar tissue within the vessel that otherwise could lead to re-narrowing. This study will evaluate the effects of 2 FDA-approved metallic stents with different designs that may have important effects on regional plaque response and blood flow dynamics immediately after stent deployment and stent healing at 12 months follow up.

Read the detailed description

The past two decades have registered major advances in cardiovascular medicine that have improved patients' survival and quality of life. One area of major research and innovation is the field of percutaneous coronary interventions (PCI), a non-surgical procedure used to treat a narrowed heart artery with stents. Stents are metallic tubular supports placed inside a blood vessel to relieve an obstruction and restore blood flow to the heart muscle. Stents could also be coated with a drug (drug-eluting stents - DES) that improves local healing and inhibits growth of scar tissue (smooth muscle and fibrous cells) within the vessel that otherwise could lead to re-narrowing.

The investigators study will evaluate two FDA-approved DES, currently in use, with respect to coronary vessel healing and long term patency. These include the XIENCE Xpedition Everolimus drug-eluting stent (X-EES) from Abbott Vascular and Resolute Integrity® Zotarolimus drug-eluting stent (R-ZES) from Medtronic, Inc, both of which have been shown in large clinical trials to be safe and effective. This study will evaluate the effects of apparently subtle differences in stent design between these two platforms that may have important effects on regional plaque response and blood flow dynamics immediately after stent deployment and stent healing and scar formation at 12 months follow up.

Several aspect of the R-ZES compared to the X-EES design may result in more favorable regional plaque response and blood flow dynamics immediately after stent deployment. These include a more compliant stent design made of a single sinusoidal wire with no connector between struts that is likely to be more comformable to a curved or angulated coronary vessels. In heart vessels which are not angulated, these features may not make a major difference in outcomes as studies already suggest. Whereas, in narrowed arteries which are curved or angulated, the use of X-EES could result in more straightening of the vessel's natural curvature and more disturbance in flow patterns. In contrast, the use of R-ZES in angulated arteries could cause less hemodynamic disturbances. There is a great deal of data suggesting that disturbances in local blood flow patterns and creation of eddy currents ('turbulent' blood flow) could adversely affect stent healing and exacerbate neointimal tissue growth.

Using two intravascular imaging technologies, the optical coherence tomography (OCT) and intravascular ultrasound (IVUS), this study aims to investigate differences in scar tissue coverage within the stented region and the degree of narrowing at the edges of the stent in patients undergoing clinically-indicated PCI (with R-ZES and X-EES) at 12-month follow-up.

Being tested
Resolute Integrity Zotarolimus eluting stent, Xience Xpedition everolimus eluting stent, Optical Coherence Tomography (OCT), Intravascular Ultrasound (IVUS)
Keywords
neointimal tissue area, angulated coronary vessels, wall shear stress, zotarolimus eluting stent, everolimus eluting stent
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.

  • Resolute Integrity Zotarolimus eluting stentDevice

    PCI with Resolute stent

  • Xience Xpedition everolimus eluting stentDevice

    PCI with Xience stent

  • Optical Coherence Tomography (OCT)Device

    Optical coherence tomography (OCT) will be performed at baseline to assess plaque burden prior to and after stent deployment as well as to evaluate stent expansion and stent apposition. OCT will be repeated at one year follow-up to evaluate neo-intimal tissue coverage within the stent and change in plaque area at the stent edges. Offline, manual detection of lumen area and stent area will be performed for each OCT cross-section from baseline and follow up examinations.

  • Intravascular Ultrasound (IVUS)Device

    Intravascular ultrasound (IVUS) will be performed at baseline to assess plaque burden prior to and after stent deployment as well as to evaluate stent expansion and stent apposition. IVUS will be repeated at one year follow-up to evaluate neo-intimal tissue coverage within the stent and change in plaque area at the stent edges. Offline, manual detection of lumen area, stent area, vessel area (external elastic membrane) and the media-adventitia interface will be performed for each IVUS cross-section from baseline and follow up examinations.

Study groups in NCT02098876
Study groupRoleWhat they receive
Resolute Integrity DESActive comparatorResolute Integrity zotarolimus eluting stent
Receives: Device: Resolute Integrity Zotarolimus eluting stent; Device: Optical Coherence Tomography (OCT); Device: Intravascular Ultrasound (IVUS)
Xience Xpedition DESActive comparatorXience Xpedition everolimus eluting stent
Receives: Device: Xience Xpedition everolimus eluting stent; Device: Optical Coherence Tomography (OCT); Device: Intravascular Ultrasound (IVUS)

What is being measured

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

  1. In Stent Mean Cross-sectional Area of Neo-intimal Tissue Coverage

    Cross-sectional area in neointimal hyperplasia by Optical Coherence Tomography (OCT) at 1 year following stent placement

    Measured: 1 year

Secondary outcomes (7)
  1. In Stent: Mean Thickness of Strut Coverage at Follow up

    Mean thickness of strut coverage at follow up (In-Stent safety endpoint). Struts have been considered as covered when tissue overlying the struts is >0 μm by optical coherence tomography (OCT)

    Measured: 1 year

  2. In-Stent: Degree of Vascular Straightening Post-percutaneous Coronary Intervention (PCI) (In-Stent Mechanistic Endpoint)

    post PCI angulation by Angio: In-Stent: Degree of vascular straightening post-percutaneous coronary intervention (PCI) (In-Stent mechanistic endpoint)

    Measured: Immediately after stent implantation

  3. In Stent: Plaque Prolapse Post-PCI (In-Stent Mechanistic Endpoint)

    Plaque will be identified by Optical Coherence Tomography (OCT)- In-Stent: Plaque prolapse post-PCI (In-Stent mechanistic endpoint)

    Measured: Immediately after stent implantation

  4. In-Stent: Percent Area of Low Wall Shear Stress (WSS)-(In-Stent Mechanistic Endpoint)

    The % area of low wall shear stress immediately after stent implantation will be measured by Optical Coherence Tomography (OCT)

    Measured: Immediately after stent implantation

  5. Stent Edge -Change in Plaque Area (Efficacy Endpoint) at 5 mm Proximal and Distal to Stent.

    Change in plaque area at the stent edges will be calculated from the change in plaque area in the 5 mm proximal and distal segments by intravascular ultrasound (IVUS); calculated as follow-up values minus baseline values

    Measured: 1 year

  6. Stent Edge: Degree of Vascular Straightening Post-percutaneous Coronary Intervention (PCI) at the Stent Edges (Stent Edge Mechanistic Endpoint)

    Degree of vascular straightening post-percutaneous coronary intervention (PCI) at the stent edges (Stent Edge mechanistic endpoint) will be measured post PCI angulation by Angio

    Measured: Immediately after stent implantation

  7. Stent Edge: Percent Area With Low Wall Shear Stress (WSS) at Stent Edges Post-PCI (Mechanistic Endpoint)

    The % area of low wall shear stress in the 5 mm proximal and distal segments immediately after stent implantation will be measured by intravascular ultrasound (IVUS).

    Measured: Immediately after stent implantation

Timeline

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

  1. First posted28 Mar 2014 (estimated)
  2. Study startMay 2014
  3. Primary completionDec 2020
  4. Study completionDec 2020

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 N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Participant
Enrolment
86 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02098876
Sponsor's protocol ID
IRB00066353
Acronym
SHEAR-STENT
Status last verified
Aug 2022
First submitted
10 Jan 2014
Last updated
9 Sep 2022
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
Yes
Individual data sharing
No

Publications

  • Molony DS, Hung O, Corban M, Gogas B, Lefieux A, Shah I, Komilian K, Adams A, Sykalo C, Dodoo S, Kumar A, Kumar S, Azarnoosh J, Piccinelli M, McDaniel MC, King SB, Maynard C, Chatzizisis YS, Chen SL, Shin ES, Stankovic G, Milasinovic D, Erglis A, Otake H, Akasaka T, Escaned J, Kwon-Koo B, Wook-Nam C, Won KB, Murasato Y, Lee WY, Lee SH, Hahn JY, Lee JM, Giddens DP, Veneziani A, Samady H. A randomized prospective study investigating the relationship between post-PCI wall shear stress and 12-month neointimal healing: The SHEAR-STENT study. Cardiovasc Revasc Med. 2026 Jul;88:57-65. doi: 10.1016/j.carrev.2025.11.001. Epub 2025 Nov 15.

    PubMed 41285658

Questions about this trial

What is this clinical trial studying?

A study testing Resolute Integrity Zotarolimus eluting stent, Xience Xpedition everolimus eluting stent and Optical Coherence Tomography (OCT) in people with Coronary Artery Disease, run by Emory University at 10 sites in 7 countries.

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 4 inclusion and 16 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 9 Sep 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 10 sites in South Korea, Japan, United States, China, Latvia and 2 more countries. 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.

Are results available for this study?

Yes. Results are posted in the registry (first posted 9 Sep 2022). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

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?

In Stent Mean Cross-sectional Area of Neo-intimal Tissue Coverage (time frame: 1 year). 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 NCT02098876, 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 9 Sep 2022.

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