Shockwave Induced Attenuation of Calcified Plaques Quantified With OCT

Launched by UNIVERSITY OF ROME TOR VERGATA · Jul 25, 2023

Keywords

ClinConnect Summary

This clinical trial is studying a new treatment for patients with severe coronary artery calcification, which can cause blockages in the heart's blood vessels. The researchers want to see if a special device called the Shockwave System can help break up the calcium in these blockages, making it easier for doctors to perform a procedure called percutaneous coronary intervention (PCI) to restore blood flow. The study will use advanced imaging technology to measure the impact of the treatment on the calcium in the arteries.

To be eligible for the trial, participants should be between 65 and 75 years old and have specific heart conditions that require PCI. This includes having a significant blockage in the coronary arteries that has not been treated before and showing signs of reduced blood flow to the heart. Participants will need to be able to take certain medications for at least six months and meet other health criteria. If you decide to join, you will receive monitoring and care throughout the process, and the trial aims to provide valuable information about this potential new treatment for heart disease.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • Subjects with native coronary artery disease (including stable or unstable angina and silent ischemia) suitable for PCI
• • Left ventricular ejection fraction (LVEF) ≥35% as measured prior to enrollment
• • eGFR ≥45 ml/min (Cockroft-Gault, MDRD)
• • Troponin must be less than or equal to the upper limit of lab normal value within 24 hours prior to the procedure or if troponin is elevated, concomitant CK must be normal
• • Ability to tolerate dual antiplatelet therapy (i.e. aspirin and clopidogrel, prasugrel, or ticagrelor) for at least 6 months (for patient not on oral anticoagulation) and single antiplatelet therapy for life
• • The target lesion must be a de novo coronary lesion that has not been previously treated with any interventional procedure
• • Single de novo target lesion stenosis of LAD, RCA or LCX (or of their branches) with stenosis of ≥70% and \<100% or stenosis ≥50% and \<70% (visually assessed) with evidence of ischemia via positive stress test, or fractional flow reserve value ≤0.80, or iFR \<0.89 or IVUS or OCT minimum lumen area ≤4.0 mm²
• • Reference vessel must have 2.5 mm - 4.0 mm diameter and ≤ 30 mm length
• • Evidence of calcification at the lesion site assessed by angiography, with fluoroscopic radio-opacities noted without cardiac motion prior to contrast injection involving both sides of the arterial wall in at least one location and total length of calcium of at least 15 mm and extending partially into the target lesion, or by IVUS or OCT, with presence of ≥270 degrees of calcium on at least 1 cross section
• • Planned treatment of single lesion for every target vessel
• • Ability to pass a 0.014" guide wire across the lesion
• • The target vessel must have a TIMI flow 3 at baseline
• Exclusion Criteria:
• • Left ventricular ejection fraction (LVEF) \<35%
• • Subject is pregnant or nursing
• • eGFR \<45 ml/min (Cockroft-Gault, MDRD) or chronic dialysis
• • Untreated pre-procedural haemoglobin \<9 g/dL or intention to refuse blood transfusions if one should become necessary
• • Patient has a platelet count \<100,000 cells/mm3 or \>750,000 cells/mm3
• • Patient has a known allergy to protocol required medications (clopidogrel, thienopyridines, aspirin, contrast media) that cannot be adequately premedicated
• • Uncontrolled diabetes defined as a fasting hyperglycaemia \>200 mg/dL or HbA1c greater than or equal to 10%
• • Patient has had a cerebrovascular accident (CVA) or transient ischemic attack (TIA) within the past 6 months, or has any permanent neurologic defect that may cause non-compliance with the protocol
• • Patient has an active peptic ulcer or active gastrointestinal (GI) bleeding
• • Patient has a history of coagulopathy
• • Subject is participating in another research study involving an investigational agent (pharmaceutical, biologic, or medical device) that has not reached the primary endpoint
• • Subjects with a life expectancy of less than 1 year
• • Subject refusing or not a candidate for emergency coronary artery bypass grafting (CABG) surgery
• • Planned use of atherectomy, scoring or cutting balloon, or any investigational device other than lithotripsy
• • Stent implantation in the target vessel within the last year or a stent within 10 mm of the target lesion
• • Definite or possible thrombus (by angiography or intravascular imaging) in the target vessel
• • Angiographic evidence of a dissection in the target vessel at baseline or after guidewire passage