With Left Main Coronary Artery Lesions
Conditions
Keywords
Polymer-based Sirolimus-Eluting Stent
Brief summary
Left main coronary artery (LMCA) is a major branch of coronary artery and supplies a large bulk of myocardium. Percutaneous coronary intervention (PCI) using contemporary drug eluting stent (DES) is one of the treatment options for patients with significant LMCA disease and suitable anatomy as multiple randomized controlled trials and meta-analysis have demonstrated the feasibility and safety of PCI in the treatment of LMCA disease. There are a few challenges in LMCA PCI due to certain anatomical and structural factors. The LMCA disease frequently involves bifurcations which requires special considerations such as side-branch access and preservation in order to prevent procedural related myocardial infarction (MI). Implantation of a metallic scaffold across the LMCA bifurcation often requires aggressive post-dilatation of the LMCA stent due to the diameter discrepancy between the side-branch and the LMCA main body. However, overexpansion beyond the rated diameter might compromise the stent integrity and radial force, resulting in mal-apposition, vascular recoil and risk of subsequent target lesion failure (TLF). The Angiolite stent is a thin-strut cobalt-chromium sirolimus-eluting stent with an open-cell design and a high overexpansion capacity that might overcomes some of these challenges in LMCA PCI. The ANGIOLITE randomized trial confirmed the non-inferiority of the Angiolite stent against the conventional DES. However, patients with LMCA involvement were specifically excluded from the trial. We therefore propose to investigate the procedural and 24 months clinical performance of the Angiolite stent in the treatment of patients with LMCA lesions.
Detailed description
Left main coronary artery (LMCA) is a major branch of coronary artery and supplies a large bulk of myocardium. Percutaneous coronary intervention (PCI) using contemporary drug eluting stent (DES) is one of the treatment options for patients with significant LMCA disease and suitable anatomy as multiple randomized controlled trials and meta-analysis have demonstrated the feasibility and safety of PCI in the treatment of LMCA disease. There are a few challenges in LMCA PCI due to certain anatomical and structural factors. The LMCA disease frequently involves bifurcations which requires special considerations such as side-branch access and preservation in order to prevent procedural related myocardial infarction (MI). Implantation of a metallic scaffold across the LMCA bifurcation often requires aggressive post-dilatation of the LMCA stent due to the diameter discrepancy between the side-branch and the LMCA main body. However, overexpansion beyond the rated diameter might compromise the stent integrity and radial force, resulting in mal-apposition, vascular recoil and risk of subsequent target lesion failure (TLF). The Angiolite stent is a thin-strut cobalt-chromium sirolimus-eluting stent with an open-cell design and a high overexpansion capacity that might overcomes some of these challenges in LMCA PCI. The ANGIOLITE randomized trial confirmed the non-inferiority of the Angiolite stent against the conventional DES. However, patients with LMCA involvement were specifically excluded from the trial. We therefore propose to investigate the procedural and 24 months clinical performance of the Angiolite stent in the treatment of patients with LMCA lesions.
Interventions
DEVICEPercutaneous coronary intervention (PCI)
Patients is under Percutaneous coronary intervention (PCI) by using contemporary drug eluting stent (DES). Angiolite is a thin-strut cobalt-chromium durable fluoroacrylate polymer-based, sirolimus-eluting stent that is CE marked and commercially available. Stent sizes 2.0mm to 4.5mm in 9mm to 49mm lengths will be used.
Sponsors
Chinese University of Hong Kong
Study design
Observational model
CASE_ONLY
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
19 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Subject age \>18. 2. Subject (or legal guardian) understands the trial requirements and treatment procedures and provides written informed consent. 3. Indication for a percutaneous coronary intervention (PCI) in native epicardial arteries involving left main coronary artery, including patients with stable coronary artery disease and acute coronary syndromes (non-ST-elevated myocardial infarction and ST-elevation myocardial infarction). 4. Target lesion must have a stenosis of \>50% and \<100% angiographically. 5. Target lesion much have an angiographic reference vessel diameter of 2.0-6.0 mm. 6. All lesions requiring PCI should be amendable for implantation of study stents.
Exclusion criteria
1. Known history of an allergic reaction or significant sensitivity to sirolimus or other analogue or derivative. 2. Known history of an allergic reaction or significant sensitivity to fluoroacrylate or its analogue or derivative. 3. Pregnant or breastfeeding woman. 4. Currently participating in another device study that has not completed the primary end point or that clinically interferes with the current study endpoints.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| change in Device oriented clinical endpoint (DOCE) | baseline, 1 month, 6 months, 12 months, 24 months | Device oriented clinical endpoint (DOCE) defined as a composite of cardiovascular death, myocardial infarction (Q-wave and non-Q wave), emergent coronary artery bypass graft surgery, target vessel myocardial infarction (TV-MI) or repeat clinically driven target-lesion revascularization (TLR) by percutaneous or surgical methods. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Lesion successful rate | baseline, 1 month, 6 months, 12 months, 24 months | Lesion successful rate is achieving less than 30% residual stenosis on angiography after the usage of the study device with lesion preparation and post-dilatation. |
| Device successful rate | baseline, 1 month, 6 months, 12 months, 24 months | Device successful rate is successful implantation of the study device at the target lesions |
| Procedural successful rate | baseline, 1 month, 6 months, 12 months, 24 months | Procedural successful rate is lesion success and no DOCE during the index hospitalization. |
Countries
Hong Kong
Outcome results
None listed