Angioplasty, Coronary Artery Calcification
Conditions
Keywords
Optical Coherence Tomography, OCT, minimal stent area(MSA)
Brief summary
Calcified lesions are very frequent among coronary artery disease stenotic lesions. The prevalence of calcifications ranges from 30 to 40% (by angiography evaluation) but is higher when analyzed by intra coronary imaging. Calcified lesions are very frequent among coronary artery disease stenotic lesions. The prevalence of calcifications ranges from 30 to 40% (by angiography evaluation) but is higher when analyzed by intra coronary imaging. The presence of calcifications increases the risk of adverse evolution after PCI , including stent restenosis, thrombosis and need for repeat revascularisation. Specific and appropriate tools can be used for calcified lesions management , including high pressure non compliant balloons, intravascular lithotripsy and rotablator. Intra vascular OCT has a high sensitivity and specificity for calcium detection among coronary artery lesions. Compared to IVUS, OCT allows a better quantification of calcium sheets (depth extension ) . Several intra coronary imaging based calcified lesions management algorithms have been proposed , but none have been validated in clinical practice.
Interventions
PROCEDUREangioplasty
Coronary angioplasty, also called percutaneous coronary intervention, is a procedure used to open clogged heart arteries. Angioplasty uses a tiny balloon catheter that is inserted in a blocked blood vessel to help widen it and improve blood flow to the heart
Sponsors
Abbott
Institut Mutualiste Montsouris
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 100 Years
Healthy volunteers
No
Inclusion criteria
1. Patient with chronic coronary syndrome 2. Angiographically moderately to severely calcified target lesion, defined as follows: * Moderate: lesion with radio-opacities noted only during the cardiac cycle before contrast dye injection (Aksoy et al., Circ Cardiovasc Interv 2019) * Severe: lesion with radio-opacities seen without cardiac motion before contrast dye injection, visible on both sides of the arterial lumen(Aksoy et al., Circ Cardiovasc Interv 2019) 3. Possibility to cross the target lesion with OCT catheter
Exclusion criteria
1. On-going cardiogenic shock 2. Acute coronary syndrome related to target lesion 3. Severe renal failure (Creatinine clearance: 30 ml/min/m2) 4. Impossibility to cross target lesion with OCT catheter & balloons, 5. Indication for Rotablator device as first line therapy 6. Pregnancy 7. Age \< 18 y 8. Denial to provide consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The primary endpoint of the CALIPSO study is the minimal stent area (MSA) on the final OCT run | During the procedure | The crude minimal stent area (MSA) will be measured along the stent on the target lesion. Stent geometric expansion will be evaluated by the DOCTORS criteria for non-bifurcated segments (Meneveau et, Circulation 2016) and LEMON criteria for bifurcated segments (Amabile et al;, Eurointervention 2020). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Residual post PCI (Percutaneous Coronary Intervention)stenosis (assessed by QCA methods) | during procedure | Qualitative Comparative Analysis (QCA) is a methodology that enables the analysis of multiple cases in complex situations |
| Residual major struts malapposition: crude incidence and quantification | during procedure | malapposition was defined as a lack of contact of at least 1 strut with the underlying vessel wall (at least 150 μm, in the absence of a side branch) with evidence of blood flow behind the strut. It was classified as major malapposition if there was evidence of at least 30% of the struts in one frame. |
| Major adverse cardiovascular events at 30 days and 1 year | at 30 days and 1 year | Cardiovascular death + Any myocardial infarction + need for re-intervention on the target lesion (TLR) |
| Peri-procedural MI according to the SCAI definition (23) | during procedure | according to the SCAI definition (Moussa et al., Journal of the American College of Cardiology 2013) |
| Geometrical stent expansion (%) according to the DOCTORS or LEMON criteria | during procedure | After the stent is deployed, the blood flow dynamics influence the mechanics by compressing and expanding the structure. |
| Radiation dose | during procedure | Differences in dose radiation used during le procedure |
| Total Contrast medium volume | during procedure | Differences in amount of contrast drug used during le procedure |
| Procedure duration | 24th post-operative hour | differences in duration (time) of the procedure |
| Coronary artery perforation: incidence | during the procedure and During the full participation period (1 year).] | Coronary perforation was defined as evidence of extravasation of dye or blood from the coronary artery during or following the interventional procedure |
Countries
France
Contacts
Primary ContactNicolas Amabile, MD PhD
Backup ContactSilvia Burbassi, PhD
Outcome results
None listed