Shockwave Coronary Rx Lithoplasty® Study (Disrupt CAD I)
Primary Purpose
Coronary Artery Disease
Status
Completed
Phase
Not Applicable
Locations
International
Study Type
Interventional
Intervention
Shockwave Coronary Rx Lithoplasty® System
Sponsored by
About this trial
This is an interventional treatment trial for Coronary Artery Disease focused on measuring Coronary Artery Disease, Calcified Coronary Lesions, Coronary Arterial Stenosis
Eligibility Criteria
Inclusion Criteria:
- Patient is ≥ 18 years of age
- Troponin must be less than or equal to the upper limit of lab normal value within 12 hours prior to the procedure
- The target vessel must have a TIMI flow 3 at baseline
- Patients with significant (≥ 50% diameter stenosis) native coronary artery disease including stable or unstable angina and silent ischemia, suitable for PCI
- Ability to tolerate dual antiplatelet agent (i.e. aspirin, clopidogrel, prasugrel, or ticagrelor for 1 year and single antiplatelet therapy for life
- Single lesion stenosis of protected LMCA, or LAD, RCA or LCX artery ≥50% in a reference vessel of 2.5 mm - 4.0 mm diameter and ≤ 32 mm length
- Presence of calcification within the lesion on both sides of the vessel as assessed by angiography
- Planned treatment of single lesions in one vessel
- Ability to pass a 0.014" guide wire across the lesion
- Patient, or authorized representative, signs a written Informed Consent form to participate in the study, prior to any study-mandated procedures
- Patient is able and willing to comply with all assessments in the study
Exclusion Criteria:
- Concomitant use of Atherectomy, Specialty balloon, or investigational coronary devices
- Prior PCI procedure within the last 30 days of the index procedure
- Patient has planned cardiovascular interventions within 30 days post index procedure
- Second lesion with ≥50% stenosis in the same target vessel
- Left ventricular ejection fraction < 40%
- Patient refusing or not a candidate for emergency coronary artery bypass grafting (CABG) surgery
- Uncontrolled severe hypertension (systolic BP >180 mm Hg or diastolic BP >110 mm Hg)
- Severe renal failure with serum creatinine >2.5 mg/dL
- Untreated pre-procedural hemoglobin <10 g/dL
- Coagulopathy manifested by platelet count <100,000 or International Normalized ratio (INR) >1.7 (INR is only required in patients who have taken warfarin within 2 weeks of enrollment)
- Patients in cardiogenic shock
- Acute myocardial infarction (MI) within the past one (1) month, and/or elevated Troponin-I or T (with concomitant elevation of CPK) at the time of enrollment.
- History of a stroke or transient ischemic attack (TIA) within 3 months
- NYHA class III or IV heart failure
- Active peptic ulcer or upper gastrointestinal (GI) bleeding within 6 months
- Patients with a life expectancy of less than 1 year
- Target vessel < 2.4 mm in diameter
- Target lesion > 32 mm in length
- Chronic Total Occlusion (CTO)
- Previous stent procedure within 5 mm of target lesion
- Angiographic evidence of a target lesion severe dissection prior to Coronary Lithoplasty treatment
- Unprotected Left Main diameter stenosis ≥ 50%
- Visible thrombus (by angiography) at target lesion site
- Target lesion is located in a native vessel distal to anastomosis with a saphenous vein graft or LIMA/RIMA bypass
- Patient has active systemic infection
- Patient has connective tissue disease (e.g., Marfan's syndrome)
- Patient has a hypercoagulable disorder
- Uncontrolled insulin dependent diabetes
- Patient has allergy to imaging contrast media for which they cannot be pre-medicated
- Evidence of aneurysm in target vessel
- Patient is pregnant or nursing
Sites / Locations
- Monash Heart, Monash Health
- St. Vincent's Hospital
- Clinic Pastuer
- Thoraxcenter, Erasmus MC
- Skane University Hospital- Lund
- King's College Hospital
- Royal Brompton Hospital
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
Lithoplasty System
Arm Description
Shockwave Coronary Rx Lithoplasty® System is a lithotripsy-enhanced, low-pressure balloon dilation of calcified, stenotic de novo coronary arteries prior to stent placement
Outcomes
Primary Outcome Measures
Safety - Frequency of Major Adverse Cardiac Events (MACE) Within 30 Days of the Procedure.
MACE defined as:
Cardiac death
Myocardial Infarction - defined as a CK-MB level > 3 times the upper limit of lab normal (ULN) value with or without new pathologic Q wave
TVR - defined as revascularization at the target vessel (inclusive the target lesion) after the completion of the index procedure
Performance
The ability of the Shockwave System to produce acceptable residual stenosis (<50%) after stenting with no evidence of in-hospital MACE.
Clinical success measured by each patient that achieves both these requirements.
Secondary Outcome Measures
Quantitative Assessment of the Residual Stenosis in Treated Lesions
Angiographic success defined as success in facilitating stent deliver with <50% residual stenosis and without serious angiographic complications. Serious angiographic complications defined as severe dissection (Type D to F), perforation, abrupt closure, and persistent slow flow or persistent no reflow
180 Day MACE
MACE defined as:
Cardiac death
Myocardial Infarction - defined as a CK-MB level > 3 times the upper limit of lab normal (ULN) value with or without new pathologic Q wave
TVR - defined as revascularization at the target vessel (inclusive the target lesion) after the completion of the index procedure
Full Information
NCT ID
NCT02650128
First Posted
December 22, 2015
Last Updated
March 14, 2018
Sponsor
Shockwave Medical, Inc.
1. Study Identification
Unique Protocol Identification Number
NCT02650128
Brief Title
Shockwave Coronary Rx Lithoplasty® Study (Disrupt CAD I)
Official Title
Prospective Multi-Center, Single Arm Study of the Shockwave Coronary Rx Lithoplasty® System in Coronary Arteries
Study Type
Interventional
2. Study Status
Record Verification Date
March 2018
Overall Recruitment Status
Completed
Study Start Date
December 2015 (Actual)
Primary Completion Date
September 2016 (Actual)
Study Completion Date
March 2017 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Shockwave Medical, Inc.
4. Oversight
Data Monitoring Committee
No
5. Study Description
Brief Summary
Prospective, multi-center, single arm study designed to evaluate the safety and performance of the Shockwave Coronary Rx Lithoplasty® System to treat calcified lesions in the coronary arteries for the purpose of enhancing the placement of stents and reducing the ultimate residual stenosis. Patients will be followed through discharge and at 30 and 180 days.
Detailed Description
Prospective, multi-center, single arm study designed to evaluate the safety and performance of the Shockwave Coronary Rx Lithoplasty® System to treat calcified lesions in the coronary arteries for the purpose of enhancing the placement of stents and reducing the ultimate residual stenosis. Patients will be enrolled and consented in the study based on history and in some instances an angiogram obtained prior to the study. The study is designed to demonstrate that the Shockwave device can safely and effectively deliver localized shockwave energy for balloon dilatation of calcified, stenotic, coronary arteries. Subjects will be prepared for PCI per the institution's standard protocol. Medications will be administered per the treatment protocol. Femoral access will be obtained using a 6F access sheath, and guiding catheter placed at the ostia of the right or left coronary artery. Baseline angiography of the culprit lesion will be performed prior to placement of a 0.014" guide wire. Baseline and either IVUS or OCT will be performed to determine the Maximum Lumen Area (MLA), percent stenosis, and volumetric lesion assessment. Baseline angiography will be performed to determine lesion length, % stenosis and reference vessel diameter. The investigational device will be prepped per the IFU and positioned at the target lesion. The distal end of the balloon catheter will be connected to the patient cable. The balloon catheter will be inflated to 4 atm and the investigator will deliver 10 pulses for 20 seconds. The balloon will then be inflated to reference vessel diameter and then deflated to reestablish flow and complete one treatment cycle. The treatment cycle will then be repeated. Angiography and either IVUS or OCT will be repeated for the treated lesion.. A coronary stent will be deployed at the site of treatment. Angiography and either IVUS or OCT will be performed following stent placement. Patients will be followed through discharge and at 30 and 180 days. A subset of up to five (5) subjects will receive an angiographic assessment at the 180 day follow up visit, per the Sponsor's discretion.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Coronary Artery Disease
Keywords
Coronary Artery Disease, Calcified Coronary Lesions, Coronary Arterial Stenosis
7. Study Design
Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
60 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Lithoplasty System
Arm Type
Experimental
Arm Description
Shockwave Coronary Rx Lithoplasty® System is a lithotripsy-enhanced, low-pressure balloon dilation of calcified, stenotic de novo coronary arteries prior to stent placement
Intervention Type
Device
Intervention Name(s)
Shockwave Coronary Rx Lithoplasty® System
Other Intervention Name(s)
Coronary Rx Lithoplasty System
Intervention Description
The Shockwave Coronary Rx Lithoplasty® System is a proprietary balloon catheter system designed to deliver localized, lithotripsy-enhanced, balloon dilatation of calcified, stenotic, de novo coronary arteries. Energizing the lithotripsy electrodes will generate pulsatile mechanical energy within the target treatment site and will disrupt calcium within the lesion and allow subsequent dilatation of a coronary artery stenosis using low balloon pressure. The system consists of a rapid exchange balloon catheter with integrated, internal lithotripsy electrodes and a Shockwave generator.
Primary Outcome Measure Information:
Title
Safety - Frequency of Major Adverse Cardiac Events (MACE) Within 30 Days of the Procedure.
Description
MACE defined as:
Cardiac death
Myocardial Infarction - defined as a CK-MB level > 3 times the upper limit of lab normal (ULN) value with or without new pathologic Q wave
TVR - defined as revascularization at the target vessel (inclusive the target lesion) after the completion of the index procedure
Time Frame
30 days
Title
Performance
Description
The ability of the Shockwave System to produce acceptable residual stenosis (<50%) after stenting with no evidence of in-hospital MACE.
Clinical success measured by each patient that achieves both these requirements.
Time Frame
Post-procedure (within 24 hours following procedure and prior to discharge)
Secondary Outcome Measure Information:
Title
Quantitative Assessment of the Residual Stenosis in Treated Lesions
Description
Angiographic success defined as success in facilitating stent deliver with <50% residual stenosis and without serious angiographic complications. Serious angiographic complications defined as severe dissection (Type D to F), perforation, abrupt closure, and persistent slow flow or persistent no reflow
Time Frame
Post-procedure (within 24 hours following procedure and prior to discharge)
Title
180 Day MACE
Description
MACE defined as:
Cardiac death
Myocardial Infarction - defined as a CK-MB level > 3 times the upper limit of lab normal (ULN) value with or without new pathologic Q wave
TVR - defined as revascularization at the target vessel (inclusive the target lesion) after the completion of the index procedure
Time Frame
180 days post-procedure
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Patient is ≥ 18 years of age
Troponin must be less than or equal to the upper limit of lab normal value within 12 hours prior to the procedure
The target vessel must have a TIMI flow 3 at baseline
Patients with significant (≥ 50% diameter stenosis) native coronary artery disease including stable or unstable angina and silent ischemia, suitable for PCI
Ability to tolerate dual antiplatelet agent (i.e. aspirin, clopidogrel, prasugrel, or ticagrelor for 1 year and single antiplatelet therapy for life
Single lesion stenosis of protected LMCA, or LAD, RCA or LCX artery ≥50% in a reference vessel of 2.5 mm - 4.0 mm diameter and ≤ 32 mm length
Presence of calcification within the lesion on both sides of the vessel as assessed by angiography
Planned treatment of single lesions in one vessel
Ability to pass a 0.014" guide wire across the lesion
Patient, or authorized representative, signs a written Informed Consent form to participate in the study, prior to any study-mandated procedures
Patient is able and willing to comply with all assessments in the study
Exclusion Criteria:
Concomitant use of Atherectomy, Specialty balloon, or investigational coronary devices
Prior PCI procedure within the last 30 days of the index procedure
Patient has planned cardiovascular interventions within 30 days post index procedure
Second lesion with ≥50% stenosis in the same target vessel
Left ventricular ejection fraction < 40%
Patient refusing or not a candidate for emergency coronary artery bypass grafting (CABG) surgery
Uncontrolled severe hypertension (systolic BP >180 mm Hg or diastolic BP >110 mm Hg)
Severe renal failure with serum creatinine >2.5 mg/dL
Untreated pre-procedural hemoglobin <10 g/dL
Coagulopathy manifested by platelet count <100,000 or International Normalized ratio (INR) >1.7 (INR is only required in patients who have taken warfarin within 2 weeks of enrollment)
Patients in cardiogenic shock
Acute myocardial infarction (MI) within the past one (1) month, and/or elevated Troponin-I or T (with concomitant elevation of CPK) at the time of enrollment.
History of a stroke or transient ischemic attack (TIA) within 3 months
NYHA class III or IV heart failure
Active peptic ulcer or upper gastrointestinal (GI) bleeding within 6 months
Patients with a life expectancy of less than 1 year
Target vessel < 2.4 mm in diameter
Target lesion > 32 mm in length
Chronic Total Occlusion (CTO)
Previous stent procedure within 5 mm of target lesion
Angiographic evidence of a target lesion severe dissection prior to Coronary Lithoplasty treatment
Unprotected Left Main diameter stenosis ≥ 50%
Visible thrombus (by angiography) at target lesion site
Target lesion is located in a native vessel distal to anastomosis with a saphenous vein graft or LIMA/RIMA bypass
Patient has active systemic infection
Patient has connective tissue disease (e.g., Marfan's syndrome)
Patient has a hypercoagulable disorder
Uncontrolled insulin dependent diabetes
Patient has allergy to imaging contrast media for which they cannot be pre-medicated
Evidence of aneurysm in target vessel
Patient is pregnant or nursing
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jean Fajadet, MD
Organizational Affiliation
Clinic Pastuer
Official's Role
Principal Investigator
Facility Information:
Facility Name
Monash Heart, Monash Health
City
Clayton
State/Province
Victoria
ZIP/Postal Code
VIC 3168
Country
Australia
Facility Name
St. Vincent's Hospital
City
Melbourne
State/Province
Victoria
ZIP/Postal Code
VIC 3065
Country
Australia
Facility Name
Clinic Pastuer
City
Toulouse
ZIP/Postal Code
BP 27617
Country
France
Facility Name
Thoraxcenter, Erasmus MC
City
Rotterdam
ZIP/Postal Code
3000 CA
Country
Netherlands
Facility Name
Skane University Hospital- Lund
City
Lund
ZIP/Postal Code
22185
Country
Sweden
Facility Name
King's College Hospital
City
London
ZIP/Postal Code
SE5 9RS
Country
United Kingdom
Facility Name
Royal Brompton Hospital
City
London
ZIP/Postal Code
SW3 6NP
Country
United Kingdom
12. IPD Sharing Statement
Citations:
PubMed Identifier
33939604
Citation
Kereiakes DJ, Di Mario C, Riley RF, Fajadet J, Shlofmitz RA, Saito S, Ali ZA, Klein AJ, Price MJ, Hill JM, Stone GW. Intravascular Lithotripsy for Treatment of Calcified Coronary Lesions: Patient-Level Pooled Analysis of the Disrupt CAD Studies. JACC Cardiovasc Interv. 2021 Jun 28;14(12):1337-1348. doi: 10.1016/j.jcin.2021.04.015. Epub 2021 May 3.
Results Reference
derived
PubMed Identifier
30715944
Citation
Brinton TJ, Ali ZA, Hill JM, Meredith IT, Maehara A, Illindala U, Lansky A, Gotberg M, Van Mieghem NM, Whitbourn R, Fajadet J, Di Mario C. Feasibility of Shockwave Coronary Intravascular Lithotripsy for the Treatment of Calcified Coronary Stenoses. Circulation. 2019 Feb 5;139(6):834-836. doi: 10.1161/CIRCULATIONAHA.118.036531. No abstract available.
Results Reference
derived
Learn more about this trial
Shockwave Coronary Rx Lithoplasty® Study (Disrupt CAD I)
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