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Carotid Artery DiseasesOPTIMANCT04234854

OPTIMAl Endovascular Exclusion of Consecutive Patient High-risk Carotid Plaque Using the MicroNet Covered Stent

An observational study of Carotid Artery Diseases, run by John Paul II Hospital, Krakow at 1 site in Poland.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

Prospective, multicentric, multispecialty, international, open-label, single arm study using per-protocol intravascular ultrasound [IVUS, 20MHz electronic phase-array transducer] to document the procedure result of an effective plaque exclusion from the vessel lumen. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Carotid Artery Diseases
What is being tested?
Intravascular Utrasound (IVUS) of Carotid Artery after implantation of CGuard stent
How many people
200 participants
Where
1 sitePoland
Study dates
31 Jan 2020to Mar 2023
Phase
Observational
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

Study population: Consecutive clinically-symptomatic patients (ipsilateral cerebral or retinal stroke or TIA with the preceding 6 months) with atherosclerotic de novo carotid artery stenosis causing at least 50% lumen reduction by quantitative carotid catheter angiography (QCA) or carotid stenosis of at least 50% lumen reduction by QCA in relation to documented ipsilateral ischaemic brain lesions/infarct on CT or MRI.

Who may be able to join

  • All consecutive patients with clinically symptomatic carotid stenosis , or carotid stenosis associated with ipisilateral cerebral ischemic infarct/s on CT or MRI/DWI imaging, referred and accepted by the study center for CAS as per local standard referral pathways and study center routine.
  • Patient informed consent to participate.
  • Patient accepts follow-up scheme and consents to follow-up visits.

Who cannot join

  • Lack of indication to carotid revascularization as per current ESC/ESVS Guidelines, or any clinical or angiographic or other contraindication to CAS (such as renal failure defined as creatinine level > 2.5 mg/dL or eGFR <20 ml/kg min, or incompatibility with DAPT).
  • Surgery within the preceding 30 days or planned surgery within 30 days after CAS.
  • Life expectancy <1 year (eg. neoplastic disease).
  • MI within 72h prior to CAS.
  • Known coagulopathy.
  • History of cerebral stroke with documented/known cause other than carotid disease.
Show all 10Show fewer
  • Atrial fibrillation or flutter.
  • Any known cause for potential cerebral embolization different than carotid stenosis.
  • History of intracranial bleeding.
  • Any contraindications to as per IFU study device implantation.

Trial locations and contacts

1 site in 1 country.

Piotr Musialek, Prof. contact

+48126142287

p.musialek@szpitaljp2.krakow.pl

Poland1 site, 1 recruiting
  • Department of Cardiac and Vascular Diseases, The John Paul II Hospital

    Krakow, Maloplska, 31-202

    Piotr Musialek, Prof, +48126142287, p.musialek@szpitaljp2.krakow.pl

    Recruiting

Other trials in Poland

About this study

Official title: OPTIMAl Endovascular Exclusion of High-risk Carotid Plaque Using the CGuard™ Stent in Patients With Symptoms or Signs of Carotid Stenosis-related Brain Injury: IVUS Controlled Investigator Initiated Multcentric Multi-specialty Study

Prospective, multicentric, multispecialty, international, open-label, single arm study using per-protocol intravascular ultrasound [IVUS, 20MHz electronic phase-array transducer] to document the procedure result of an effective plaque exclusion from the vessel lumen.

Read the detailed description

Investigator initiated, academic, single arm, open-label, non-randomized, prospective, multicenter, multispecialty trial of CGuard™ use in all-comer population of consecutive patients with carotid stenosis related cerebral symptoms (TIA, stroke, retinal TIA, retinal stroke) or signs of ipsilateral brain injury on MRI or CT imaging.

The main objective of this observational study is to evaluate an incidence of residual plaque prolapse after carotid stenting using the study device.

Study Rationale In conventional carotid stents, plaque prolapse (PP) on intravascular imaging had been determined to be strongly associated with new post-procedural diffusion-weighted magnetic resonance lesions on cerebral imaging and with increased ischaemic stroke incidence. A significant increase in PP susceptibility was observed with unstable carotid plaque, pointing to the limitations of conventional CAS in unstable carotid plaques, such as symptomatic and increased-spontaneous-symptoms-risk lesions.

This is reflected in current guidelines that provide a higher recommendation class to surgical management (CEA) rather than CAS for symptomatic lesions.

Circumstantial evidence indicates that the novel carotid stent covered with MicroNET (CGuard EPS) may be an optimal device for effective carotid plaque sequestration (that may be particularly relevant in high-risk plaques) - but no systematic study has been performed thus far.

Because of the increasing evidence that not only clinical symptoms (that may be related to for instance the affection of dominant vs. non-dominant haemisphere) but also signs of ipisilateral cerebral infarct/s are a hallmark of high-risk plaque and are associated with adverse prognosis, and because that neurology increasingly uses the term "symptomatic" to refer to carotid stenosis associated with clinically silent ipisilateral cerebral infarct/s, the present study will enroll both patients with clinical symptoms of cerebral ischaemia in relation to carotid stenosis and those with (clinically silent) signs of ipsilateral injury such as ischemic focus/foci on CT or MRI/DW-MRI).

As previously demonstrated, clinically significant/relevant PP is that depicted by IVUS (with angiography, on the one hand, being not sensitive enough and OCT, on the other, being possibly too sensitive).

Being tested
Intravascular Utrasound (IVUS) of Carotid Artery after implantation of CGuard stent
Keywords
Stenting
Medical subject headings
Carotid Artery Diseases

What participants receive

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

  • Intravascular Utrasound (IVUS) of Carotid Artery after implantation of CGuard stentDiagnostic test

    IVUS will be performed after stent postdilatation to determine the incidence of plaque prolapse. Additionally optimizing stent expansion with IVUS is left at operator discretion.

Study groups in NCT04234854
Study groupRoleWhat they receive
Carotid Artery StentingConsecutive patients older than 18 yrs with symptomatic carotid artery stenosis qualified for endovascular revascularization.
Receives: Diagnostic Test: Intravascular Utrasound (IVUS) of Carotid Artery after implantation of CGuard stent

What is being measured

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

  1. Freedom from plaque prolapse

    Freedom from plaque prolapse defined as observation of plaque inside the stent lumen after completion of the CAS procedure by IVUS assessment (Kotsugi 2017).

    Measured: During index procedure

Secondary outcomes (9)
  1. Procedural success

    stent delivery and implantation in absence of an intra-procedural clinical major adverse event, with no more than 30% residual diameter stenosis by on-site QCA, and successful withdrawal of the stent delivery and neuroprotection system

    Measured: During index procedure

  2. IVUS interrogation success

    IVUS interrogation with an effective IVUS probe removal in absence of any clinical complications

    Measured: During index procedure

  3. Endovascular lumen reconstruction

    Freedom from plaque prolapse plus minimal in-stent area >50% ICA reference area

    Measured: During index procedure

  4. Periprocedural MACCE

    Death, stroke, myocardial infarction until discharge or up to 24 hours

    Measured: Until discharge or up to 24 hours

  5. 30 days MACCE

    Death, stroke, myocardial infarction until 30 days

    Measured: 30 days

  6. Any periprocedural complications

    Any complications occurring until discharge or 24 hours whichever comes first

    Measured: Until discharge or up to 24 hours

  7. Ipsilateral stroke between 31 days and 12 months after the procedure

    Ipsilateral stroke between 31 days and 12 months after the procedure

    Measured: Between 31 days and 12 months after the procedure

  8. Duplex UltraSound (DUS) at 30 days

    Peak Systolic Velocity (PSV) and End Diastolic Velocity (EDV) recorded by Duplex Doppler at 30±5 days after the procedure

    Measured: 30 days

  9. Duplex UltraSound (DUS) at 12 months

    Peak Systolic Velocity (PSV) and End Diastolic Velocity (EDV) recorded by Duplex Doppler at 12 months after the procedure

    Measured: 12 months

Timeline

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

  1. First posted21 Jan 2020
  2. Study start31 Jan 2020
  3. Primary completionDec 2022 (estimated)
  4. Study completionMar 2023 (estimated)

Resources

More details

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

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
200 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04234854
Sponsor's protocol ID
OPTIMA
Acronym
OPTIMA
Status last verified
Oct 2021
First submitted
16 Jan 2020
Last updated
20 Oct 2021
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Kotsugi M, Takayama K, Myouchin K, Wada T, Nakagawa I, Nakagawa H, Taoka T, Kurokawa S, Nakase H, Kichikawa K. Carotid Artery Stenting: Investigation of Plaque Protrusion Incidence and Prognosis. JACC Cardiovasc Interv. 2017 Apr 24;10(8):824-831. doi: 10.1016/j.jcin.2017.01.029.

    PubMed 28427600
  • Musialek P, Pieniazek P, Tracz W, Tekieli L, Przewlocki T, Kablak-Ziembicka A, Motyl R, Moczulski Z, Stepniewski J, Trystula M, Zajdel W, Roslawiecka A, Zmudka K, Podolec P. Safety of embolic protection device-assisted and unprotected intravascular ultrasound in evaluating carotid artery atherosclerotic lesions. Med Sci Monit. 2012 Feb;18(2):MT7-18. doi: 10.12659/msm.882452.

    PubMed 22293887
  • Clark DJ, Lessio S, O'Donoghue M, Schainfeld R, Rosenfield K. Safety and utility of intravascular ultrasound-guided carotid artery stenting. Catheter Cardiovasc Interv. 2004 Nov;63(3):355-62. doi: 10.1002/ccd.20188.

    PubMed 15505835
  • Bandyk DF, Armstrong PA. Use of intravascular ultrasound as a "Quality Control" technique during carotid stent-angioplasty: are there risks to its use? J Cardiovasc Surg (Torino). 2009 Dec;50(6):727-33.

    PubMed 19935603
  • Hitchner E, Zhou W. Utilization of Intravascular Ultrasound during Carotid Artery Stenting. Int J Angiol. 2015 Sep;24(3):185-8. doi: 10.1055/s-0035-1556081. Epub 2015 Jul 10.

    PubMed 26417186
  • Musialek P, Hopf-Jensen S. Commentary: Carotid Artery Revascularization for Stroke Prevention: A New Era. J Endovasc Ther. 2017 Feb;24(1):138-148. doi: 10.1177/1526602816671263. Epub 2016 Oct 13. No abstract available.

    PubMed 27733691
  • Schofer J, Musialek P, Bijuklic K, Kolvenbach R, Trystula M, Siudak Z, Sievert H. A Prospective, Multicenter Study of a Novel Mesh-Covered Carotid Stent: The CGuard CARENET Trial (Carotid Embolic Protection Using MicroNet). JACC Cardiovasc Interv. 2015 Aug 17;8(9):1229-1234. doi: 10.1016/j.jcin.2015.04.016.

    PubMed 26292586
  • Musialek P, Mazurek A, Trystula M, Borratynska A, Lesniak-Sobelga A, Urbanczyk M, Banys RP, Brzychczy A, Zajdel W, Partyka L, Zmudka K, Podolec P. Novel PARADIGM in carotid revascularisation: Prospective evaluation of All-comer peRcutaneous cArotiD revascularisation in symptomatic and Increased-risk asymptomatic carotid artery stenosis using CGuard MicroNet-covered embolic prevention stent system. EuroIntervention. 2016 Aug 5;12(5):e658-70. doi: 10.4244/EIJY16M05_02.

    PubMed 27180302
  • Ruffino MA, Faletti R, Fronda M, Gatti M, Bergamasco L, Gibello L, Varetto G, Righi D, Rispoli P, Fonio P. Early Embolization After Carotid Artery Stenting with Mesh-Covered Stent: Role of Diffusion-Weighted Magnetic Resonance Imaging as Pre-procedural Predictor and Discriminant Between Intra- and Post-procedural Events. Cardiovasc Intervent Radiol. 2019 Jun;42(6):812-819. doi: 10.1007/s00270-019-02173-1. Epub 2019 Feb 19.

    PubMed 30783778
  • Speziale F, Capoccia L, Sirignano P, Mansour W, Pranteda C, Casana R, Setacci C, Accrocca F, Alberti D, de Donato G, Ferri M, Gaggiano A, Galzerano G, Ippoliti A, Mangialardi N, Pratesi G, Ronchey S, Ruffino A, Siani A, Spinazzola A, Sponza M. Thirty-day results from prospective multi-specialty evaluation of carotid artery stenting using the CGuard MicroNet-covered Embolic Prevention System in real-world multicentre clinical practice: the IRON-Guard study. EuroIntervention. 2018 Feb 20;13(14):1714-1720. doi: 10.4244/EIJ-D-17-00008.

    PubMed 28485278
  • Musialek P, Grunwald IQ. How asymptomatic is "asymptomatic" carotid stenosis? Resolving fundamental confusion(s) - and confusions yet to be resolved. Pol Arch Intern Med. 2017 Nov 30;127(11):718-719. doi: 10.20452/pamw.4157. Epub 2017 Nov 30. No abstract available.

    PubMed 29192895
  • Stabile E, Sannino A, Schiattarella GG, Gargiulo G, Toscano E, Brevetti L, Scudiero F, Giugliano G, Perrino C, Trimarco B, Esposito G. Cerebral embolic lesions detected with diffusion-weighted magnetic resonance imaging following carotid artery stenting: a meta-analysis of 8 studies comparing filter cerebral protection and proximal balloon occlusion. JACC Cardiovasc Interv. 2014 Oct;7(10):1177-83. doi: 10.1016/j.jcin.2014.05.019. Epub 2014 Sep 17.

    PubMed 25240544
  • Wissgott C, Schmidt W, Brandt-Wunderlich C, Behrens P, Andresen R. Clinical Results and Mechanical Properties of the Carotid CGUARD Double-Layered Embolic Prevention Stent. J Endovasc Ther. 2017 Feb;24(1):130-137. doi: 10.1177/1526602816671134. Epub 2016 Oct 13.

    PubMed 27733689
  • Stabile E, de Donato G, Musialek P, De Loose K, Nerla R, Sirignano P, Chianese S, Mazurek A, Tesorio T, Bosiers M, Setacci C, Speziale F, Micari A, Esposito G. Use of Dual-Layered Stents in Endovascular Treatment of Extracranial Stenosis of the Internal Carotid Artery: Results of a Patient-Based Meta-Analysis of 4 Clinical Studies. JACC Cardiovasc Interv. 2018 Dec 10;11(23):2405-2411. doi: 10.1016/j.jcin.2018.06.047.

    PubMed 30522670
  • Casana R, Tolva V, Odero A Jr, Malloggi C, Paolucci A, Triulzi F, Silani V. Safety and Efficacy of the New Micromesh-Covered Stent CGuard in Patients Undergoing Carotid Artery Stenting: Early Experience From a Single Centre. Eur J Vasc Endovasc Surg. 2017 Dec;54(6):681-687. doi: 10.1016/j.ejvs.2017.09.015. Epub 2017 Oct 28.

    PubMed 29089282

Questions about this trial

What is this clinical trial studying?

An observational study of Carotid Artery Diseases, run by John Paul II Hospital, Krakow at 1 site in Poland.

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 3 inclusion and 10 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: status not confirmed, as of the sponsor's last update on 20 Oct 2021. 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 Poland. 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?

Results are not available in the source record.

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

Contact Piotr Musialek, Prof. (+48126142287, p.musialek@szpitaljp2.krakow.pl), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Freedom from plaque prolapse (time frame: During index procedure). 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 NCT04234854, which also lists 30 linked publications.

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 20 Oct 2021.

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