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First-In-Human Trial of the MiStent Drug-Eluting Stent (DES) in Coronary Artery Disease (DESSOLVE-I)

Primary Purpose

Coronary Artery Disease

Status
Completed
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
MiStent SES
Sponsored by
Micell Technologies
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Coronary Artery Disease focused on measuring Coronary Artery Disease, Drug-eluting Stent, Sirolimus

Eligibility Criteria

18 Years - 85 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Male/female patients 18-85 years;
  2. Stable or unstable angina pectoris, ischemia, or silent ischemia;
  3. Planned single, de novo, types A, B1 and B2 coronary lesions;
  4. Target lesion located in a native coronary artery;
  5. Target lesion vessel diameter 2.5 to 3.5 mm amenable to treatment with a maximum 23 mm long stent;
  6. Target lesion >50% diameter stenosis;
  7. Patients eligible for percutaneous coronary intervention (PCI);
  8. Acceptable candidate for myocardial revascularization surgery;
  9. A patient may have one additional critical non-target lesion.
  10. The patient will provide written informed consent.

Exclusion Criteria:

  1. Female of childbearing potential not on some form of birth control with a confirmed negative pregnancy test at baseline;
  2. Recent Q-wave myocardial infarction occurred <72 hours prior to the index procedure. Recent myocardial infarction with elevated levels of cardiac markers;
  3. Left ventricular ejection fraction <30%;
  4. Patients in cardiogenic shock;
  5. Cerebrovascular accident or transient ischemic attack within 6 months;
  6. Active GI bleed within three months;
  7. Any prior true anaphylactic reaction to contrast agents;
  8. Patient receiving/scheduled to receive chemotherapy within 30-days before or after the index procedure;
  9. Patient is receiving immunosuppressive therapy or has known life-limiting immunosuppressive/autoimmune disease;
  10. Renal dysfunction (creatinine > 2.0 mg/dL or 177 µmol/L);
  11. Platelet count <100,000 cells/mm³ or >700,000 cells/mm³;
  12. White blood cell count <3,000 cells/mm3;
  13. Hepatic disease;
  14. Heart transplant recipient;
  15. Known contraindication to dual antiplatelet therapy;
  16. Known hypersensitivity to sirolimus, cobalt-chromium, or to medications such as aspirin, heparin, and all three of the following: clopidogrel bisulfate (Plavix), ticlopidine (Ticlid), and Prasugrel (Effient);
  17. Life expectancy <12 months;
  18. Any major medical condition that may interfere with the optimal participation of the patient in this study;
  19. Patient is currently participating/planning to participate in an investigational drug or another device study prior to completing 12-months follow-up;
  20. Target vessel(s) has been treated within 10 mm proximal or distal to target lesion with any type of PCI within a year prior to index procedure;
  21. Planned or actual target vessel(s) treatment with an unapproved device, directional or rotational coronary atherectomy, laser, cutting balloon, or transluminal extraction catheter prior to stent placement;
  22. Previous coronary intravascular brachytherapy;
  23. Planned coronary angioplasty or coronary artery bypass grafting (CABG)in the first 9 months after the index procedure;
  24. Prior PCI of a non-target vessel must be at least 30 days prior to study enrollment;
  25. The intent to direct stent the target lesion;
  26. Angiographic Exclusion Criteria: Assessed prior to stent placement;

    • In-stent restenotic target lesion;
    • More than one lesion requiring treatment in the target vessel;
    • Target vessel diameter <2.5 mm or >3.5 mm;
    • Target lesion not amenable to treatment with a 23 mm long stent;
    • Unprotected coronary artery branch lesion (≥50% DS);
    • Target lesion located in a surgical bypass graft;
    • Total vessel occlusion;
    • Target lesion with ostial location;
    • Target lesion located in a lateral branch bifurcation >2.5mm or requiring lateral branch stenting;
    • Calcified target lesion that anticipates unsuccessful/impracticable predilation;
    • Target vessel excessive tortuosity or proximal angulation (>90 degrees);
    • Thrombus present in target vessel;
    • More than one non-target critical lesion;

Non-target lesion to be treated during the index procedure meets any of the following criteria:

  • Within the target vessel;
  • Within a bypass graft;
  • Left main location;
  • Chronic total occlusion;
  • Involves a complex bifurcation.

Sites / Locations

  • St. Vincent's Hospital Melbourne
  • Onze-Lieve-Vrouwziekenhuis Aalst (OLV Hospital)
  • Ziekenhuis Oost-Limburg
  • Auckland City Hospital
  • Mercy Angiography Unit - Mercy Hospital

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

MiStent SES

Arm Description

The MiStent SES is a device/drug combination comprised of two components; a stent and a drug product (sirolimus within an absorbable polymer coating).

Outcomes

Primary Outcome Measures

Angiographic In-Stent Late Lumen Loss
In-stent late lumen loss as measured by the angiographic core laboratory as the difference between the post-procedure minimal lumen diameters (MLD) in the treated segment (stented region) minus the MLD in the same region at follow-up.

Secondary Outcome Measures

Percentage of Participants Experiencing Major Adverse Cardiac Events (MACE)
Major Adverse Cardiac Events (MACE) defined as death, myocardial infarction (Q-wave and non-Q-wave) and target vessel revascularization (TVR)
Device Success
Achievement of a final in-stent residual diameter stenosis of <50% (by QCA), using the assigned device only
Lesion Success
Achievement of a final in-stent residual diameter stenosis of <50% (by QCA) using any percutaneous method
Procedural Success
Achievement of a final in-stent residual diameter stenosis of <50% (by QCA) using the assigned device (including any adjunctive devices) without cardiac death, Myocardial infarction (MI) or repeat revascularization of the target lesion pre-hospital discharge
Total Mortality
Total mortality (cardiac and non-cardiac)
Total Myocardial Infarction (MI)
Q-wave MI (QWMI): requires one of the following criteria: the development of new abnormal Q waves in ≥2 contiguous ECG leads not present on the patient's baseline (i.e., before intervention) in association with a >2x upper limit normal elevation of creatine kinase (CK) levels. In the absence of ECG data, the clinical events committee may adjudicate a Q-wave MI based on the clinical scenario and appropriate cardiac enzyme data; chest pain or other acute symptoms consistent with myocardial ischemia and new pathological Q waves in ≥2 contiguous ECG leads in the absence of timely cardiac enzyme data. Non-Q-wave MI (NQWMI): the elevation of CK levels (≥2 times ULN) with elevated CK-MB enzyme levels in the absence of new pathologic Q waves.
Clinically-driven Target Lesion Revascularization (TLR) Rates
A revascularization is considered clinically driven if angiography at follow-up shows a percent diameter stenosis ≥ 50% (Angiographic Core Laboratory QCA assessment) and if one of the following occurs: A positive history of recurrent angina pectoris, presumably related to the target vessel; Objective signs of ischemia at rest (ECG changes) or during exercise test (or equivalent), presumably related to the target vessel; Abnormal results of any invasive functional diagnostic test (e.g., Doppler flow velocity reserve, fractional flow reserve); A target lesion revascularization (TLR) with a diameter stenosis ≥ 70% even in the absence of the above-mentioned ischemic signs or symptoms.
Clinically-driven Target Vessel Revascularization (TVR) Rates
A revascularization is considered clinically driven if angiography at follow-up shows a percent diameter stenosis ≥ 50% (Angiographic Core Laboratory QCA assessment) and if one of the following occurs: A positive history of recurrent angina pectoris, presumably related to the target vessel; Objective signs of ischemia at rest (ECG changes) or during exercise test (or equivalent), presumably related to the target vessel; Abnormal results of any invasive functional diagnostic test (e.g., Doppler flow velocity reserve, fractional flow reserve); A target vessel revascularization (TVR) with a diameter stenosis ≥ 70% even in the absence of the above-mentioned ischemic signs or symptoms.
Target Vessel Failure (TVF)
Target vessel failure (TVF) is defined as the composite endpoint of: cardiac death, target-vessel myocardial infarction (Q wave or non-Q wave), and clinically indicated target vessel revascularization
Target Lesion Failure (TLF)
Target lesion failure (TLF) is defined as the composite endpoint of: cardiac death, target-lesion myocardial infarction (Q wave or non-Q wave), and clinically indicated target lesion revascularization
Stent Thrombosis
The presence of an intracoronary thrombus that originates in the stent or in the segments 5 mm proximal or distal to the stent post-procedure
Angiographic Evaluation: In-stent Binary Restenosis
Binary Restenosis is defined as ≥50% luminal narrowing at follow-up angiography.
Angiographic Evaluation: In-stent Binary Restenosis
Binary Restenosis is defined as ≥50% luminal narrowing at follow-up angiography.
Intravascular Ultrasound (IVUS) Evaluation: % Neointimal Volume Obstruction
% neointimal volume obstruction is defined as the neointimal volume divided by stent volume.
IVUS Evaluation: % Neointimal Volume Obstruction
% neointimal volume obstruction is defined as the neointimal volume divided by stent volume.
Optical Coherence Tomography (OCT) Evaluation: % Stent Strut Uncovered
% stent strut uncovered is defined as the ratio of uncovered struts to total struts in all cross-sections.
OCT Evaluation: % Stent Strut Uncovered
% stent strut uncovered is defined as the ratio of uncovered struts to total struts in all cross-sections.

Full Information

First Posted
November 18, 2010
Last Updated
December 15, 2016
Sponsor
Micell Technologies
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1. Study Identification

Unique Protocol Identification Number
NCT01247428
Brief Title
First-In-Human Trial of the MiStent Drug-Eluting Stent (DES) in Coronary Artery Disease
Acronym
DESSOLVE-I
Official Title
A First-In-Human Trial of a New Novel DES (MiStent System) With Sirolimus and a Bioabsorbable Polymer for the Treatment of Patients With De Novo Lesions in the Native Coronary Arteries
Study Type
Interventional

2. Study Status

Record Verification Date
December 2016
Overall Recruitment Status
Completed
Study Start Date
November 2010 (undefined)
Primary Completion Date
September 2012 (Actual)
Study Completion Date
March 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Micell Technologies

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The DESSOLVE I clinical trial is to assess the safety and performance of the sirolimus-eluting MiStent SES.
Detailed Description
The DESSOLVE I clinical trial is to assess the safety and performance of the sirolimus-eluting MiStent for the treatment for improving coronary luminal diameter in patients with symptomatic ischemic heart disease due to discrete de novo lesions < 20 mm in length in the native coronary arteries with reference vessel diameters between 2.5 mm and 3.5 mm.

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, Drug-eluting Stent, Sirolimus

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
30 (Actual)

8. Arms, Groups, and Interventions

Arm Title
MiStent SES
Arm Type
Experimental
Arm Description
The MiStent SES is a device/drug combination comprised of two components; a stent and a drug product (sirolimus within an absorbable polymer coating).
Intervention Type
Device
Intervention Name(s)
MiStent SES
Intervention Description
The MiStent SES is a device/drug combination comprised of two components; a stent and a drug product (sirolimus within an absorbable polymer coating).
Primary Outcome Measure Information:
Title
Angiographic In-Stent Late Lumen Loss
Description
In-stent late lumen loss as measured by the angiographic core laboratory as the difference between the post-procedure minimal lumen diameters (MLD) in the treated segment (stented region) minus the MLD in the same region at follow-up.
Time Frame
8 months
Secondary Outcome Measure Information:
Title
Percentage of Participants Experiencing Major Adverse Cardiac Events (MACE)
Description
Major Adverse Cardiac Events (MACE) defined as death, myocardial infarction (Q-wave and non-Q-wave) and target vessel revascularization (TVR)
Time Frame
240 days
Title
Device Success
Description
Achievement of a final in-stent residual diameter stenosis of <50% (by QCA), using the assigned device only
Time Frame
8 hours
Title
Lesion Success
Description
Achievement of a final in-stent residual diameter stenosis of <50% (by QCA) using any percutaneous method
Time Frame
8 hours
Title
Procedural Success
Description
Achievement of a final in-stent residual diameter stenosis of <50% (by QCA) using the assigned device (including any adjunctive devices) without cardiac death, Myocardial infarction (MI) or repeat revascularization of the target lesion pre-hospital discharge
Time Frame
8 hours
Title
Total Mortality
Description
Total mortality (cardiac and non-cardiac)
Time Frame
240 days
Title
Total Myocardial Infarction (MI)
Description
Q-wave MI (QWMI): requires one of the following criteria: the development of new abnormal Q waves in ≥2 contiguous ECG leads not present on the patient's baseline (i.e., before intervention) in association with a >2x upper limit normal elevation of creatine kinase (CK) levels. In the absence of ECG data, the clinical events committee may adjudicate a Q-wave MI based on the clinical scenario and appropriate cardiac enzyme data; chest pain or other acute symptoms consistent with myocardial ischemia and new pathological Q waves in ≥2 contiguous ECG leads in the absence of timely cardiac enzyme data. Non-Q-wave MI (NQWMI): the elevation of CK levels (≥2 times ULN) with elevated CK-MB enzyme levels in the absence of new pathologic Q waves.
Time Frame
240 days
Title
Clinically-driven Target Lesion Revascularization (TLR) Rates
Description
A revascularization is considered clinically driven if angiography at follow-up shows a percent diameter stenosis ≥ 50% (Angiographic Core Laboratory QCA assessment) and if one of the following occurs: A positive history of recurrent angina pectoris, presumably related to the target vessel; Objective signs of ischemia at rest (ECG changes) or during exercise test (or equivalent), presumably related to the target vessel; Abnormal results of any invasive functional diagnostic test (e.g., Doppler flow velocity reserve, fractional flow reserve); A target lesion revascularization (TLR) with a diameter stenosis ≥ 70% even in the absence of the above-mentioned ischemic signs or symptoms.
Time Frame
240 days
Title
Clinically-driven Target Vessel Revascularization (TVR) Rates
Description
A revascularization is considered clinically driven if angiography at follow-up shows a percent diameter stenosis ≥ 50% (Angiographic Core Laboratory QCA assessment) and if one of the following occurs: A positive history of recurrent angina pectoris, presumably related to the target vessel; Objective signs of ischemia at rest (ECG changes) or during exercise test (or equivalent), presumably related to the target vessel; Abnormal results of any invasive functional diagnostic test (e.g., Doppler flow velocity reserve, fractional flow reserve); A target vessel revascularization (TVR) with a diameter stenosis ≥ 70% even in the absence of the above-mentioned ischemic signs or symptoms.
Time Frame
240 days
Title
Target Vessel Failure (TVF)
Description
Target vessel failure (TVF) is defined as the composite endpoint of: cardiac death, target-vessel myocardial infarction (Q wave or non-Q wave), and clinically indicated target vessel revascularization
Time Frame
240 days
Title
Target Lesion Failure (TLF)
Description
Target lesion failure (TLF) is defined as the composite endpoint of: cardiac death, target-lesion myocardial infarction (Q wave or non-Q wave), and clinically indicated target lesion revascularization
Time Frame
240 days
Title
Stent Thrombosis
Description
The presence of an intracoronary thrombus that originates in the stent or in the segments 5 mm proximal or distal to the stent post-procedure
Time Frame
240 days
Title
Angiographic Evaluation: In-stent Binary Restenosis
Description
Binary Restenosis is defined as ≥50% luminal narrowing at follow-up angiography.
Time Frame
4 months, 6 months, 8 months
Title
Angiographic Evaluation: In-stent Binary Restenosis
Description
Binary Restenosis is defined as ≥50% luminal narrowing at follow-up angiography.
Time Frame
18 months
Title
Intravascular Ultrasound (IVUS) Evaluation: % Neointimal Volume Obstruction
Description
% neointimal volume obstruction is defined as the neointimal volume divided by stent volume.
Time Frame
8 months
Title
IVUS Evaluation: % Neointimal Volume Obstruction
Description
% neointimal volume obstruction is defined as the neointimal volume divided by stent volume.
Time Frame
18 months
Title
Optical Coherence Tomography (OCT) Evaluation: % Stent Strut Uncovered
Description
% stent strut uncovered is defined as the ratio of uncovered struts to total struts in all cross-sections.
Time Frame
8 months
Title
OCT Evaluation: % Stent Strut Uncovered
Description
% stent strut uncovered is defined as the ratio of uncovered struts to total struts in all cross-sections.
Time Frame
18 M

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
85 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male/female patients 18-85 years; Stable or unstable angina pectoris, ischemia, or silent ischemia; Planned single, de novo, types A, B1 and B2 coronary lesions; Target lesion located in a native coronary artery; Target lesion vessel diameter 2.5 to 3.5 mm amenable to treatment with a maximum 23 mm long stent; Target lesion >50% diameter stenosis; Patients eligible for percutaneous coronary intervention (PCI); Acceptable candidate for myocardial revascularization surgery; A patient may have one additional critical non-target lesion. The patient will provide written informed consent. Exclusion Criteria: Female of childbearing potential not on some form of birth control with a confirmed negative pregnancy test at baseline; Recent Q-wave myocardial infarction occurred <72 hours prior to the index procedure. Recent myocardial infarction with elevated levels of cardiac markers; Left ventricular ejection fraction <30%; Patients in cardiogenic shock; Cerebrovascular accident or transient ischemic attack within 6 months; Active GI bleed within three months; Any prior true anaphylactic reaction to contrast agents; Patient receiving/scheduled to receive chemotherapy within 30-days before or after the index procedure; Patient is receiving immunosuppressive therapy or has known life-limiting immunosuppressive/autoimmune disease; Renal dysfunction (creatinine > 2.0 mg/dL or 177 µmol/L); Platelet count <100,000 cells/mm³ or >700,000 cells/mm³; White blood cell count <3,000 cells/mm3; Hepatic disease; Heart transplant recipient; Known contraindication to dual antiplatelet therapy; Known hypersensitivity to sirolimus, cobalt-chromium, or to medications such as aspirin, heparin, and all three of the following: clopidogrel bisulfate (Plavix), ticlopidine (Ticlid), and Prasugrel (Effient); Life expectancy <12 months; Any major medical condition that may interfere with the optimal participation of the patient in this study; Patient is currently participating/planning to participate in an investigational drug or another device study prior to completing 12-months follow-up; Target vessel(s) has been treated within 10 mm proximal or distal to target lesion with any type of PCI within a year prior to index procedure; Planned or actual target vessel(s) treatment with an unapproved device, directional or rotational coronary atherectomy, laser, cutting balloon, or transluminal extraction catheter prior to stent placement; Previous coronary intravascular brachytherapy; Planned coronary angioplasty or coronary artery bypass grafting (CABG)in the first 9 months after the index procedure; Prior PCI of a non-target vessel must be at least 30 days prior to study enrollment; The intent to direct stent the target lesion; Angiographic Exclusion Criteria: Assessed prior to stent placement; In-stent restenotic target lesion; More than one lesion requiring treatment in the target vessel; Target vessel diameter <2.5 mm or >3.5 mm; Target lesion not amenable to treatment with a 23 mm long stent; Unprotected coronary artery branch lesion (≥50% DS); Target lesion located in a surgical bypass graft; Total vessel occlusion; Target lesion with ostial location; Target lesion located in a lateral branch bifurcation >2.5mm or requiring lateral branch stenting; Calcified target lesion that anticipates unsuccessful/impracticable predilation; Target vessel excessive tortuosity or proximal angulation (>90 degrees); Thrombus present in target vessel; More than one non-target critical lesion; Non-target lesion to be treated during the index procedure meets any of the following criteria: Within the target vessel; Within a bypass graft; Left main location; Chronic total occlusion; Involves a complex bifurcation.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
William Wijns, MD
Organizational Affiliation
Cardiovascular Center, Onze-Lieve-Vrouwziekenhuis Aalst (OLV Hospital)
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
John Ormiston, MD
Organizational Affiliation
Mercy Angiography Unit
Official's Role
Principal Investigator
Facility Information:
Facility Name
St. Vincent's Hospital Melbourne
City
Melbourne
Country
Australia
Facility Name
Onze-Lieve-Vrouwziekenhuis Aalst (OLV Hospital)
City
Aalst
Country
Belgium
Facility Name
Ziekenhuis Oost-Limburg
City
Genk
Country
Belgium
Facility Name
Auckland City Hospital
City
Auckland
ZIP/Postal Code
1032
Country
New Zealand
Facility Name
Mercy Angiography Unit - Mercy Hospital
City
Aukland
ZIP/Postal Code
1032
Country
New Zealand

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
24055443
Citation
Ormiston J, Webster M, Stewart J, Vrolix M, Whitbourn R, Donohoe D, Knape C, Lansky A, Attizzani GF, Fitzgerald P, Kandzari DE, Wijns W. First-in-human evaluation of a bioabsorbable polymer-coated sirolimus-eluting stent: imaging and clinical results of the DESSOLVE I Trial (DES with sirolimus and a bioabsorbable polymer for the treatment of patients with de novo lesion in the native coronary arteries). JACC Cardiovasc Interv. 2013 Oct;6(10):1026-34. doi: 10.1016/j.jcin.2013.05.013. Epub 2013 Sep 18.
Results Reference
result
PubMed Identifier
23992957
Citation
Attizzani GF, Bezerra HG, Ormiston J, Wang W, Donohoe D, Wijns W, Costa MA. Serial assessment by optical coherence tomography of early and late vascular responses after implantation of an absorbable-coating Sirolimus-Eluting stent (from the first-in-human DESSOLVE I trial). Am J Cardiol. 2013 Nov 15;112(10):1557-64. doi: 10.1016/j.amjcard.2013.07.013. Epub 2013 Aug 29.
Results Reference
result

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First-In-Human Trial of the MiStent Drug-Eluting Stent (DES) in Coronary Artery Disease

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