Chronic Total Occlusion of Coronary ArteryNCT04917432
Early and Midterm Outcomes of Intravascular Ultrasound (IVUS) Versus Non-IVUS Guidance in Complex Coronary Chronic Total Occlusion (CTO) Revascularization.
A study testing intravascular ultrasound (IVUS) and Conventional CTO PCI (non-IVUS guided) in people with Chronic Total Occlusion of Coronary Artery, run by Assiut University.
Trial summary
Various CTO percutaneous coronary intervention (PCI) studies defined CTO as as a substantial atherosclerotic blockage with >3 months duration of TIMI (Thrombolysis in Myocardial Infarction) 0 flow other than via collaterals. Read more about this study
- Who is it for?
- Any age
- Conditions the study is for
- Chronic Total Occlusion of Coronary Artery
- What is being tested?
- intravascular ultrasound (IVUS) and Conventional CTO PCI (non-IVUS guided)
- Type of treatment
- Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 70 participants
- Where
- No sites listed yet
- Study dates
- 1 Sep 2022to 30 Sep 2025
- Phase
- Interventional
- 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 Any age
- All sexes
- No healthy volunteers
- Child, Adult, Older adult
Who may be able to join
- All coronary CTO patients in whom coronary anatomy is defined by coronary CT and/or Coronary angiography provided that:- CTO defined as heavy atherosclerotic occlusion with TIMI (Thrombolysis in Myocardial Infarction) 0 flow other than via collaterals for >3 months and they are symptomatic despite optimal medical therapy and/or positive high risk stress modality.
Who cannot join
- Acute coronary syndrome within 3 months.
- Patients with renal insufficiency (eGFR < 60 ml/kg/m2, serum creatinine ≥ 2.5 mg/dL, or on regular dialysis).
- Patients with expected post CTO-PCI procedure SYNTAX >10.
- Hemodynamically unstable patients.
Trial locations and contacts
No sites are listed yet.
About this study
Various CTO percutaneous coronary intervention (PCI) studies defined CTO as as a substantial atherosclerotic blockage with >3 months duration of TIMI (Thrombolysis in Myocardial Infarction) 0 flow other than via collaterals. Following CTO-PCI, various well-established therapeutic benefits have been extensively acknowledged, such as improved angina frequency score and quality of life score from the Seattle Angina Questionnaire (SAQ). Patients are currently referred for CTO PCI to relieve symptoms, reduce ischemia load, or pursue full revascularization to improve left ventricular ejection fraction (LVEF) CTO-PCI is one of the most difficult procedures in interventional cardiology today. Although IVUS has been demonstrated to improve long-term results during CTO PCI when used for stent optimization, its impact on crossing has received little research. IVUS imaging can aid in the resolution of proximal cap ambiguity by determining the position of the main branch and determining the position of the guidewire during CTO crossing efforts both antegrade and retrograde. For the reverse controlled antegrade and retrograde tracking and dissection (reverse CART) procedure, IVUS can help establish the best balloon size. In addition, imaging guidance can help in balloon and stent sizing, as well as stent expansion and strut apposition.
The function of IVUS in CTO PCI has been a source of contention among the four major CTO schools hybrid algorithms. The importance of IVUS-guided entry in overcoming proximal cap uncertainty was underlined in the Asia Pacific algorithm. Furthermore, IVUS-guided wiring, limited subintimal tracking and re-entry are incorporated in the algorithm as alternatives, but only as last resorts. After performing dual coronary injections, the North American hybrid method evaluates four angiographic characteristics, the first of which is a clear understanding of the proximal cap placement utilising angiography or IVUS. They also explain how IVUS guidance can help with reverse CART by allowing for the proper balloon size selection. When proximal cap ambiguity is found in the Euro CTO club algorithm, antegrade procedures such as IVUS-guided puncture and scratch and go technique are performed. When using a primary retrograde approach, the probability of antegrade passing with IVUS guidance and parallel wiring, as well as the advantage of a shorter guide wire crossing time when employing an antegrade route alone, must be incorporated in the Japanese algorithm.
- Being tested
- intravascular ultrasound (IVUS), Conventional CTO PCI (non-IVUS guided)
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
intravascular ultrasound (IVUS)Procedure or surgery
Intravascular imaging using a specialized catheter delivered through intra-arterial approach to reach the coronaries to guide CTO-PCI procedure and optimize the results after wire crossing.
Conventional CTO PCI (non-IVUS guided)Procedure or surgery
Non-IVUS guided CTO PCI for wiring but may be used for results optimization after wire crossing
| Study group | Role | What they receive |
|---|---|---|
| IVUS guided CTO revascularization | Active comparator | To assess the effects of IVUS usage in CTO revascularization compared to conventional non-IVUS guided CTO-PCI as regard technical success and procedural success, MACE within 6 months. Receives: Procedure: intravascular ultrasound (IVUS) |
| Non-IVUS guided CTO revascularization | Active comparator | To compare this conventional non-IVUS guided CTO-PCI arm with the other IVUS guided arm as regard technical success and procedural success, MACE within 6 months. Receives: Procedure: Conventional CTO PCI (non-IVUS guided) |
What is being measured
The primary outcome is the main question the study is designed to answer.
Technical success
Restoration of antegrade flow with residual stenosis below 30% assessed using IVUS by measuring the minimal lumenal area in mm2
Measured: Within three to six hours
procedural success
technical success without in-hospital MACE (death, myocardial infarction, need for urgent PCI or CABG and stroke).
Measured: within three days
major adverse cardiovascular events (MACE)
death, myocardial infarction, repeat target vessel revascularization with either PCI or coronary artery bypass graft surgery and stroke
Measured: within six months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted8 Jun 2021
- Study start1 Sep 2022 (estimated)
- Primary completion30 Sep 2024 (estimated)
- Study completion30 Sep 2025 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (6)Papers the sponsor has linked to this study.
- Other trials for Chronic Total Occlusion of Coronary ArteryStudies of the same condition, open and under way.
- More trials run by Assiut UniversityThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
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
- Investigator
- Enrolment
- 70 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Assiut University
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Khaled Saber Abdelaal Qayed, Assiut University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT04917432
- Sponsor's protocol ID
- Chronic total occlusion
- Status last verified
- Jun 2021
- First submitted
- 27 May 2021
- Last updated
- 8 Jun 2021
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Undecided
Publications
Galassi AR, Werner GS, Boukhris M, Azzalini L, Mashayekhi K, Carlino M, Avran A, Konstantinidis NV, Grancini L, Bryniarski L, Garbo R, Bozinovic N, Gershlick AH, Rathore S, Di Mario C, Louvard Y, Reifart N, Sianos G. Percutaneous recanalisation of chronic total occlusions: 2019 consensus document from the EuroCTO Club. EuroIntervention. 2019 Jun 20;15(2):198-208. doi: 10.4244/EIJ-D-18-00826.
PubMed 30636678Hong SJ, Kim BK, Shin DH, Kim JS, Hong MK, Gwon HC, Kim HS, Yu CW, Park HS, Chae IH, Rha SW, Lee SH, Kim MH, Hur SH, Jang Y; K-CTO Registry. Usefulness of intravascular ultrasound guidance in percutaneous coronary intervention with second-generation drug-eluting stents for chronic total occlusions (from the Multicenter Korean-Chronic Total Occlusion Registry). Am J Cardiol. 2014 Aug 15;114(4):534-40. doi: 10.1016/j.amjcard.2014.05.027. Epub 2014 Jun 6.
PubMed 25001153Park Y, Park HS, Jang GL, Lee DY, Lee H, Lee JH, Kang HJ, Yang DH, Cho Y, Chae SC, Jun JE, Park WH. Intravascular ultrasound guided recanalization of stumpless chronic total occlusion. Int J Cardiol. 2011 Apr 14;148(2):174-8. doi: 10.1016/j.ijcard.2009.10.052. Epub 2009 Nov 26.
PubMed 19942305Dai J, Katoh O, Kyo E, Tsuji T, Watanabe S, Ohya H. Approach for chronic total occlusion with intravascular ultrasound-guided reverse controlled antegrade and retrograde tracking technique: single center experience. J Interv Cardiol. 2013 Oct;26(5):434-43. doi: 10.1111/joic.12066.
PubMed 24106742Estevez-Loureiro R, Ghione M, Kilickesmez K, Agudo P, Lindsay A, Di Mario C. The role for adjunctive image in pre-procedural assessment and peri-procedural management in chronic total occlusion recanalisation. Curr Cardiol Rev. 2014 May;10(2):120-6. doi: 10.2174/1573403x10666140331143731.
PubMed 24694101Kalogeropoulos AS, Alsanjari O, Davies JR, Keeble TR, Tang KH, Konstantinou K, Vardas P, Werner GS, Kelly PA, Karamasis GV. Impact of Intravascular Ultrasound on Chronic Total Occlusion Percutaneous Revascularization. Cardiovasc Revasc Med. 2021 Dec;33:32-40. doi: 10.1016/j.carrev.2021.01.008. Epub 2021 Jan 12.
PubMed 33461936
Study at a glance
From the registry record, last updated by the sponsor on 8 Jun 2021. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Early and Midterm Outcomes of Intravascular Ultrasound (IVUS) Versus Non-IVUS Guidance in Complex Coronary Chronic Total Occlusion (CTO) Revascularization.
- ClinicalTrials.gov ID
- NCT04917432
- Acronym / sponsor ID
- Chronic total occlusion
- Study type
- Interventional
- Recruitment status
- Unknown status
- Enrolment
- 70 participants (estimated)
- Lead sponsor
- Assiut UniversityUniversity, hospital or other
- Study start
- 1 Sep 2022 (estimated)
- Primary completion
- 30 Sep 2024 (estimated)
- Study completion
- 30 Sep 2025 (estimated)
- First posted
- 8 Jun 2021 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Various CTO percutaneous coronary intervention (PCI) studies defined CTO as as a substantial atherosclerotic blockage with >3 months duration of TIMI (Thrombolysis in Myocardial Infarction) 0 flow other than via collaterals. Following CTO-PCI, various well-established therapeutic benefits have been extensively acknowledged, such as improved angina frequency score and quality of life score from the Seattle Angina Questionnaire (SAQ). Patients are currently referred for CTO PCI to relieve symptoms, reduce ischemia load, or pursue full revascularization to improve left ventricular ejection fraction (LVEF) CTO-PCI is one of the most difficult procedures in interventional cardiology today. Although IVUS has been demonstrated to improve long-term results during CTO PCI when used for stent optimization, its impact on crossing has received little research. IVUS imaging can aid in the resolution of proximal cap ambiguity by determining the position of the main branch and determining the position of the guidewire during CTO crossing efforts both antegrade and retrograde. For the reverse controlled antegrade and retrograde tracking and dissection (reverse CART) procedure, IVUS can help establish the best balloon size. In addition, imaging guidance can help in balloon and stent sizing, as well as stent expansion and strut apposition.
The function of IVUS in CTO PCI has been a source of contention among the four major CTO schools hybrid algorithms. The importance of IVUS-guided entry in overcoming proximal cap uncertainty was underlined in the Asia Pacific algorithm. Furthermore, IVUS-guided wiring, limited subintimal tracking and re-entry are incorporated in the algorithm as alternatives, but only as last resorts. After performing dual coronary injections, the North American hybrid method evaluates four angiographic characteristics, the first of which is a clear understanding of the proximal cap placement utilising angiography or IVUS. They also explain how IVUS guidance can help with reverse CART by allowing for the proper balloon size selection. When proximal cap ambiguity is found in the Euro CTO club algorithm, antegrade procedures such as IVUS-guided puncture and scratch and go technique are performed. When using a primary retrograde approach, the probability of antegrade passing with IVUS guidance and parallel wiring, as well as the advantage of a shorter guide wire crossing time when employing an antegrade route alone, must be incorporated in the Japanese algorithm.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (investigator)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| IVUS guided CTO revascularization | Active comparator | Procedure: intravascular ultrasound (IVUS)To assess the effects of IVUS usage in CTO revascularization compared to conventional non-IVUS guided CTO-PCI as regard technical success and procedural success, MACE within 6 months. |
| Non-IVUS guided CTO revascularization | Active comparator | Procedure: Conventional CTO PCI (non-IVUS guided)To compare this conventional non-IVUS guided CTO-PCI arm with the other IVUS guided arm as regard technical success and procedural success, MACE within 6 months. |
Who may qualify
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child, Adult, Older adult
Key inclusion criteria (1 listed)
- All coronary CTO patients in whom coronary anatomy is defined by coronary CT and/or Coronary angiography provided that:- CTO defined as heavy atherosclerotic occlusion with TIMI (Thrombolysis in Myocardial Infarction) 0 flow other than via collaterals for >3 months and they are symptomatic despite optimal medical therapy and/or positive high risk stress modality.
Key exclusion criteria (4 listed)
- Acute coronary syndrome within 3 months.
- Patients with renal insufficiency (eGFR < 60 ml/kg/m2, serum creatinine ≥ 2.5 mg/dL, or on regular dialysis).
- Patients with expected post CTO-PCI procedure SYNTAX >10.
- Hemodynamically unstable patients.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| intravascular ultrasound (IVUS)Intravascular imaging using a specialized catheter delivered through intra-arterial approach to reach the coronaries to guide CTO-PCI procedure and optimize the results after wire crossing. | Procedure or surgery | IVUS guided CTO revascularization |
| Conventional CTO PCI (non-IVUS guided)Non-IVUS guided CTO PCI for wiring but may be used for results optimization after wire crossing | Procedure or surgery | Non-IVUS guided CTO revascularization |
Primary outcome
Technical success
Time frame: Within three to six hours
Restoration of antegrade flow with residual stenosis below 30% assessed using IVUS by measuring the minimal lumenal area in mm2
procedural success
Time frame: within three days
technical success without in-hospital MACE (death, myocardial infarction, need for urgent PCI or CABG and stroke).
major adverse cardiovascular events (MACE)
Time frame: within six months
death, myocardial infarction, repeat target vessel revascularization with either PCI or coronary artery bypass graft surgery and stroke
Results and safety
Results are not available in the source record.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 8 Jun 2021.
- Background: PubMed 30636678Galassi AR, Werner GS, Boukhris M, Azzalini L, Mashayekhi K, Carlino M, Avran A, Konstantinidis NV, Grancini L, Bryniarski L, Garbo R, Bozinovic N, Gershlick AH, Rathore S, Di Mario C, Louvard Y, Reifart N, Sianos G. Percutaneous recanalisation of chronic total occlusions: 2019 consensus document from the EuroCTO Club. EuroIntervention. 2019 Jun 20;15(2):198-208. doi: 10.4244/EIJ-D-18-00826.
- Background: PubMed 25001153Hong SJ, Kim BK, Shin DH, Kim JS, Hong MK, Gwon HC, Kim HS, Yu CW, Park HS, Chae IH, Rha SW, Lee SH, Kim MH, Hur SH, Jang Y; K-CTO Registry. Usefulness of intravascular ultrasound guidance in percutaneous coronary intervention with second-generation drug-eluting stents for chronic total occlusions (from the Multicenter Korean-Chronic Total Occlusion Registry). Am J Cardiol. 2014 Aug 15;114(4):534-40. doi: 10.1016/j.amjcard.2014.05.027. Epub 2014 Jun 6.
- Background: PubMed 19942305Park Y, Park HS, Jang GL, Lee DY, Lee H, Lee JH, Kang HJ, Yang DH, Cho Y, Chae SC, Jun JE, Park WH. Intravascular ultrasound guided recanalization of stumpless chronic total occlusion. Int J Cardiol. 2011 Apr 14;148(2):174-8. doi: 10.1016/j.ijcard.2009.10.052. Epub 2009 Nov 26.
- Background: PubMed 24106742Dai J, Katoh O, Kyo E, Tsuji T, Watanabe S, Ohya H. Approach for chronic total occlusion with intravascular ultrasound-guided reverse controlled antegrade and retrograde tracking technique: single center experience. J Interv Cardiol. 2013 Oct;26(5):434-43. doi: 10.1111/joic.12066.
- Background: PubMed 24694101Estevez-Loureiro R, Ghione M, Kilickesmez K, Agudo P, Lindsay A, Di Mario C. The role for adjunctive image in pre-procedural assessment and peri-procedural management in chronic total occlusion recanalisation. Curr Cardiol Rev. 2014 May;10(2):120-6. doi: 10.2174/1573403x10666140331143731.
- Background: PubMed 33461936Kalogeropoulos AS, Alsanjari O, Davies JR, Keeble TR, Tang KH, Konstantinou K, Vardas P, Werner GS, Kelly PA, Karamasis GV. Impact of Intravascular Ultrasound on Chronic Total Occlusion Percutaneous Revascularization. Cardiovasc Revasc Med. 2021 Dec;33:32-40. doi: 10.1016/j.carrev.2021.01.008. Epub 2021 Jan 12.
- Individual participant dataSharing planned: Undecided
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Questions about this trial
What is this clinical trial studying?
A study testing intravascular ultrasound (IVUS) and Conventional CTO PCI (non-IVUS guided) in people with Chronic Total Occlusion of Coronary Artery, run by Assiut University.
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 1 inclusion and 4 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 8 Jun 2021. Status can change between updates, so confirm with the study contact before making plans.
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 Khaled Qayed, Ass. lecturer (01061697848 ext. +2, khaled.saber.qayed66@aun.edu.eg), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Technical success (time frame: Within three to six hours). The study lists 3 primary outcomes in all. 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 NCT04917432, which also lists 6 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 8 Jun 2021.