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Chronic Total Occlusions of Coronary ArteriesDCB-CTONCT07463664

Clinical Outcomes of Drug-Coated Balloons in the Treatment of Patients With Coronary De Novo Chronic Total Occlusion Lesions

A study testing DES Implantation and DCB Angioplasty in people with Chronic Total Occlusions of Coronary Arteries and Chronic Total Occlusion (CTO), run by The First Affiliated Hospital of Zhengzhou University at 18 sites in China.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
Search all trials

Trial summary

The aim of this study is to evaluate the long-term efficacy and safety of drug-coated balloon (DCB) strategies, including DCB alone or hybrid strategies of DCB and drug-eluting stent (DES), compared to DES-only in patients with chronic total occlusion (CTO) after successful recanalization. Read more about this study

Who is it for?
Ages 18 to 80 years
What is being tested?
DES Implantation and DCB Angioplasty
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
200 participants
Where
18 sitesChina
Study dates
28 Apr 2025to 31 Dec 2026
Phase
Interventional
Are there results?
Not yet: the study is under way

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

Who may be able to join

  • Patient voluntarily participates in the study and has provided written informed consent.
  • Presence of clinical indication for Percutaneous Coronary Intervention (PCI) of the Chronic Total Occlusion (CTO) (e.g., symptoms of angina pectoris or evidence of myocardial ischemia).
  • Target lesion is located in a de novo coronary artery.
  • Angiographically confirmed CTO (TIMI grade 0 flow), with evidence supporting an occlusion duration of ≥ 3 months.
  • Successful guidewire crossing of the target CTO lesion has been achieved during the index procedure.
  • After adequate vessel preparation: Distal TIMI grade 3 flow has been restored; Target lesion residual diameter stenosis is < 50% (e.g., by visual estimate or QCA as per protocol); Absence of flow-limiting dissection or other complications requiring immediate stent implantation.
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  • Target vessel Reference Vessel Diameter (RVD) is between 2.25 mm and 4.0 mm (inclusive, assessed by visual estimate or QCA/IVUS as per protocol).
  • In the judgment of the interventional operator, the lesion is deemed suitable for treatment with both a Drug-Coated Balloon (DCB)-based strategy and a Drug-Eluting Stent (DES)-only strategy.
  • Patient is able and willing to comply with the study protocol requirements, including the specified follow-up schedule.
  • Female patients of childbearing potential must have a negative pregnancy test prior to enrollment and agree to use an effective method of contraception throughout the study period.

Who cannot join

  • Target CTO lesion is the culprit vessel responsible for the presenting Acute Myocardial Infarction (AMI).
  • Patient is in cardiogenic shock.
  • Presence of severe heart failure (New York Heart Association [NYHA] Class IV) or Left Ventricular Ejection Fraction (LVEF) < 30%.
  • History of stroke or Transient Ischemic Attack (TIA) within the previous 3 months.
  • Known high risk of bleeding or contraindication to Dual Antiplatelet Therapy (DAPT).
  • Presence of severe hepatic impairment and/or severe renal impairment (e.g., estimated Glomerular Filtration Rate [eGFR] < 30 ml/min/1.73m² or requirement for chronic dialysis).
Show all 15Show fewer
  • Known hypersensitivity or contraindication to required study medications (e.g., antiplatelet agents, contrast media), DCB/DES drug coatings, or device materials (e.g., stent alloys, polymers).
  • Target lesion located in an unprotected left main coronary artery, a saphenous vein graft, or an arterial graft.
  • Presence of severe lesion calcification that prevents adequate vessel expansion despite attempted lesion preparation techniques (e.g., rotational atherectomy, intravascular lithotripsy).
  • Target lesion is a CTO within a previously stented segment (In-Stent Restenosis [ISR] or In-Stent Thrombosis [IST]).
  • Failed attempt at CTO recanalization during the index procedure (i.e., failure to cross the lesion with a guidewire or failure to restore TIMI grade 3 flow).
  • Occurrence of a complication after vessel preparation that necessitates immediate stent implantation (e.g., flow-limiting dissection, perforation requiring a covered stent).
  • Concurrent enrollment in another interventional clinical trial that may interfere with the study endpoints or assessments.
  • Female patient is pregnant or breastfeeding.
  • Patient judged by the investigator to be unsuitable for the study for any reason, including anticipated poor compliance with the protocol.

Trial locations and contacts

18 sites in 1 country. Contact the study team or a site near you to ask about taking part.

Liang Pan, Doctor contact

+86-15003851743

huzhoupanliang@163.com

18 sites in 1 country

China18 sites, 18 recruiting
  • Anyang District Hospital

    Anyang, Henan, 455000

    Yongcun Hu, +86 13598130938, cunhuyong@126.com

    Yongcun Hu

    Recruiting
  • Fuwai Hospital Chinese Academy of Medical Sciences (CAMS)

    Beijing, Beijing Municipality, 100037

    Ru Liu, +86 15901098523, liuru@fuwaihospital.org

    Ru Liu

    Not yet recruiting
  • The People's Hospital of Jiaozuo

    Jiaozuo, Henan, 454002

    Haijun Zheng, +86 13938150080, jzsrmyyhj@163.com

    Haijun Zheng

    Not yet recruiting
  • Jincheng People's Hospital

    Jincheng, Shanxi, 048026

    Sancong Pan, Doctor, +86 13753663616, psc456789@163.com

    Sancong Pan, Doctor

    Recruiting
  • The second people's Hospital of Jiyuan

    Jiyuan, Henan, 454000

    Ruilu Xue, +86 13569118879, xuerl888@sohu.com

    Runlu Xue

    Recruiting
  • Huaihe Hospital of Henan University

    Kaifeng, Henan, 475000

    Xiaoming Zhong, +86 13503783659, zxm10020202@126.com

    Xiaoming Zhong

    Recruiting
  • Kaifeng Central Hospital

    Kaifeng, Henan, 475000

    Jieyun Liu, +86 13803786051, ljy6051@126.com

    Jieyun Liu

    Recruiting
  • The First Affiliated Hospital of Henan University of Science and Technology

    Luoyang, Henan, 471003

    Zhijuan Li, +86 13838836086, 13838836086@126.com

    Zhijuan Li

    Recruiting
  • Nanyang City Center Hospital

    Nanyang, Henan, 473000

    Zhiliang Zhang, +86 18736560527, 18736560527@qq.com

    Zhiliang Zhang

    Not yet recruiting
  • The Second People's Hospital of Pingdingshan

    Pingdingshan, Henan, 467000

    Ling Zhang, +86 15537591366, zlpds@163.com

    Ling Zhang

    Recruiting
  • Puyang People's Hospital

    Puyang, Henan, 457099

    Wenyuan Wang, +86 13693930161, wangwenyuan@163.com

    Wenyuan Wang

    Recruiting
  • Yellow River Sanmenxia hospital

    Sanmenxia, Henan, 472000

    Chaohong Zhang, +86 13803981169, 13803981169@126.com

    Chaohong Zhang

    Not yet recruiting
  • Tianjin Fourth Central Hospital

    Tianjin, Tianjin Municipality, 300074

    Shangyu Wen, +86 13704676597, liyonghuitj@163.com

    Shangyu Wen

    Not yet recruiting
  • Xinyang Central Hospital

    Xinyang, Henan, 464000

    Tan Xu, +86 18539258144, 18539258144@163.com

    Tan Xu

    Not yet recruiting
  • The First Affiliated Hospital of Henan University of CM

    Zhengzhou, Henan, 450000

    Minghua Luo, +86 15837199858, lmhuaaaa@163.com

    Minghua Luo

    Not yet recruiting
  • Zhengzhou Central Hospital

    Zhengzhou, Henan, 450000

    Dan Wang, +86 13525531530, wangdan1762@126.com

    Dan Wang

    Not yet recruiting
  • People's Hospital of Zhengzhou

    Zhengzhou, Henan, 450053

    Dongyu Wan, +86 15238356077, 893592650@qq.com

    Dongyu Wan

    Not yet recruiting
  • Zhoukou Central Hospital

    Zhoukou, Henan, 466000

    Guoli Jia, +86 13592265990, yanhuaz@sina.com

    Guoli Jia

    Recruiting

Other trials in China

About this study

Official title: Clinical Outcomes of Drug-Coated Balloons in the Treatment of Patients With Coronary De Novo Chronic Total Occlusion Lesions: A Multicenter, Randomized Controlled Trial

The aim of this study is to evaluate the long-term efficacy and safety of drug-coated balloon (DCB) strategies, including DCB alone or hybrid strategies of DCB and drug-eluting stent (DES), compared to DES-only in patients with chronic total occlusion (CTO) after successful recanalization. Through a prospective, multicenter randomized controlled trial, we will directly compare the long-term outcomes of these two treatment strategies in CTO patients to fill the gap in existing research regarding direct comparative data between DCB and DES in CTO treatment. This study expects to provide high-quality evidence for optimizing CTO treatment, potentially improving treatment strategies in complex cases, reducing stent usage, lowering the risk of complications, and ultimately enhancing patient prognosis.

Read the detailed description

Background Despite significant advances in percutaneous coronary intervention (PCI) for coronary chronic total occlusion (CTO), the standard drug-eluting stent (DES) implantation strategy following successful recanalization-particularly for long-segment lesions-faces challenges associated with the "full metal jacket" phenomenon. These include increased risks of in-stent restenosis (ISR) and stent thrombosis (ST), impairment of vascular physiological function, and prolonged requirements for dual antiplatelet therapy (DAPT). Drug-coated balloon (DCB), as a "leave nothing behind" interventional technique, has demonstrated efficacy in treating DES-ISR and small vessel disease, offering a potential alternative for CTO treatment. However, its application in de novo CTO lesions remains supported by limited high-level evidence from large-scale randomized controlled trials (RCTs).

Objective This study aims to compare the long-term efficacy and safety of a DCB-based treatment strategy (including DCB alone or DCB combined with provisional DES hybrid strategy when necessary) versus standard DES-only strategy in patients with successfully recanalized native CTO lesions. The primary objective is to evaluate whether the DCB strategy is non-inferior to the DES-only strategy regarding in-segment late lumen loss (LLL) at 9 months post-procedure. Secondary objectives include comparisons of clinical endpoints (such as target lesion failure [TLF], cardiac death, myocardial infarction, and repeat revascularization), angiographic restenosis rates, patient-reported outcomes (angina, quality of life), intravascular imaging parameters, safety profiles, and cost-effectiveness between the two groups.

Methods This is a prospective, multicenter, randomized, open-label, active-controlled non-inferiority clinical trial. We plan to enroll 200 patients with successfully recanalized native CTO (reference vessel diameter 2.25-4.0 mm), who will be randomly assigned in a 1:1 ratio to either the DCB strategy group or the DES-only strategy group. The DCB group will undergo DCB angioplasty, with provisional DES implantation (hybrid strategy) permitted in cases of flow-limiting dissection or suboptimal results. The DES group will receive standard DES implantation. All patients will receive standard post-procedural medical therapy (including at least 12 months of DAPT) and will be followed up for 36 months post-procedure. The primary endpoint of in-segment LLL at 9 months will be assessed by an independent core laboratory, blinded to group allocation, using quantitative coronary angiography (QCA). Clinical endpoint events will be adjudicated by an independent Clinical Events Committee (CEC). Statistical analysis will be primarily based on the intention-to-treat (ITT) principle.

Expected Significance This study (the DCB-CTO Study) is expected to provide the first large-scale RCT evidence directly comparing DCB strategy versus DES-only strategy for de novo CTO. The findings will furnish clinicians with important evidence-based guidance for managing this complex lesion subset, potentially optimizing interventional treatment strategies for CTO, reducing metallic implant burden, and possibly improving long-term clinical outcomes for patients.

Being tested
DES Implantation, DCB Angioplasty
Keywords
drug-coated balloon, Coronary artery disease, chronic total occlusion, drug-eluting stent, clinical outcome
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.

  • DES ImplantationProcedure or surgery

    Drug-eluting stents meeting study criteria (e.g., sirolimus-, paclitaxel-, or everolimus-eluting stents; specific models selected by operators according to clinical practice) were chosen. Stent diameter was determined by the target vessel reference diameter (2.25-4.0 mm), with length covering the occluded segment plus 5 mm of healthy vessel proximal and distal to the lesion. Stents were deployed at 8-16 atm to ensure optimal apposition. Intraoperative angiography confirmed no residual stenosis (<10%) and TIMI grade 3 flow. When multiple stents were required, an overlapping technique was utilized to ensure complete lesion coverage.

  • DCB AngioplastyProcedure or surgery

    Drug-coated balloons meeting study criteria (e.g., paclitaxel- or sirolimus-coated DCB; specific models selected by operators according to clinical practice) were chosen. DCB diameter was determined by the target vessel reference diameter (2.25-4.0 mm), with length covering the occluded segment plus 5 mm proximal and distal to the lesion. DCB inflation was maintained for ≥60 seconds at 8-12 atm to ensure adequate drug delivery to the vessel wall. Intraoperative angiography confirmed <50% residual stenosis, TIMI grade 3 flow, and absence of serious complications. DES implantation was permitted (recorded as hybrid strategy) if any of the following conditions occurred after DCB application: Residual stenosis ≥50% with hemodynamic significance; Non-flow-limiting dissection requiring stent support based on operator judgment; Other technical difficulties resulting in DCB-alone treatment failure. DES selection was consistent with the DES-only group.

Study groups in NCT07463664
Study groupRoleWhat they receive
DCB GroupExperimentalDCB-only angioplasty or hybrid strategy combining DCB and DES (DCB+DES hybrid approach)
Receives: Procedure: DCB Angioplasty
DES-only GroupActive comparatorunderwent Implantation with Drug-Eluting Stent-only
Receives: Procedure: DES Implantation

What is being measured

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

  1. In-segment Late Lumen Loss, LLL

    Measured via planned, mandatory follow-up coronary angiography. Standardized, blinded analysis performed by an independent core laboratory using Quantitative Coronary Angiography (QCA). The "segment" is defined as the target lesion plus 5 mm proximal and distal margins. LLL = Post-procedure Minimum Lumen Diameter (MLD_post-procedure) - Follow-up Minimum Lumen Diameter (MLD_follow-up).

    Measured: 9 months

Secondary outcomes (7)
  1. In-segment Binary Restenosis / Re-occlusion Rate

    Determined by core laboratory QCA analysis. Defined as diameter stenosis ≥50% or TIMI 0 flow in the target lesion segment (consistent with LLL segment definition) on follow-up angiography.

    Measured: 9 months

  2. Target Lesion Failure, TLF

    Assessed through clinical follow-up, adjudicated by an independent Clinical Events Committee (CEC). Composite endpoint includes the first occurrence of cardiac death, target vessel myocardial infarction (TV-MI, per SCAI definition), or clinically driven target lesion revascularization (CD-TLR).

    Measured: 12 month (primary clinical assessment), 24 months, 36 months

  3. Cardiac Death

    Determined through clinical follow-up, adjudicated by CEC. Defined as any death due to a confirmed cardiovascular cause or sudden death where a cardiovascular cause cannot be excluded.

    Measured: 12 month, 24 months, 36 months

  4. Clinically Driven Target Lesion Revascularization (CD-TLR)

    Evaluated via clinical follow-up and angiography, adjudicated by CEC. Defined as revascularization driven by symptoms (e.g., angina) or ischemic evidence, with angiographic confirmation of target lesion diameter stenosis ≥50% or occlusion requiring intervention.

    Measured: 12 month, 24 months, 36 months

  5. Target Vessel Myocardial Infarction (TV-MI)

    Assessed through clinical follow-up, adjudicated by CEC per SCAI definition. Requires target vessel-related electrocardiographic changes (new Q-wave or ST-segment elevation) and biomarker elevation (troponin >5 times upper limit of normal).

    Measured: 12 month, 24 months, 36 months

  6. Very Late Clinical Events

    Assessed through clinical follow-up, adjudicated by CEC. Includes TLF and Major Adverse Cardiovascular Events (MACE, comprising cardiac death, MI, target vessel revascularization) occurring >1 year post-procedure.

    Measured: 24个月、36个月

  7. Angina Status Change (CCS Grading or SAQ Score Change)

    Evaluated using Canadian Cardiovascular Society (CCS) grading or Seattle Angina Questionnaire (SAQ) to assess angina frequency, severity, and physical limitation. Patient-reported data collected by study coordinators, aggregated in a blinded manner.

    Measured: Baseline vs. 6 months, 12 months, 24 months

Timeline

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

  1. First posted11 Mar 2026
  2. Study start28 Apr 2025
  3. Primary completion30 Jun 2026 (estimated)
  4. Study completion31 Dec 2026 (estimated)

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
None (open label)
Enrolment
200 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07463664
Sponsor's protocol ID
2024-KY-1551-002
Other IDs
LHGJ20230176
Acronym
DCB-CTO
Status last verified
Mar 2026
First submitted
1 Mar 2026
Last updated
11 Mar 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: The datasets used and/or analyzed in the current study will be uploaded to the public clinical trial management platform ResMan (http://www.medresman.org.cn).

Questions about this trial

What is this clinical trial studying?

A study testing DES Implantation and DCB Angioplasty in people with Chronic Total Occlusions of Coronary Arteries and Chronic Total Occlusion (CTO), run by The First Affiliated Hospital of Zhengzhou University at 18 sites in China.

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 10 inclusion and 15 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: looking for participants now, as of the sponsor's last update on 11 Mar 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 18 sites in China. 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?

This study is still under way. Results are not available in the source record yet.

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

Contact Liang Pan, Doctor (+86-15003851743, huzhoupanliang@163.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

In-segment Late Lumen Loss, LLL (time frame: 9 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 11 Mar 2026.

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