The objective of the study is to compare angiographic outcomes of Selution sirolimus coated balloon (MedAlliance) versus SeQuent Please Neo paclitaxel coated balloon (Bbraun) for the treatment of de novo coronary artery lesions in medium size vessels (\>2.00 mm and ≤3.00 mm) with respect to Net Gain (mm) and Fractional Flow Reserve (FFR) at 12 months follow-up.
This is a prospective, randomized, multicenter, no-profit and post-market study in subjects with small vessels, i.e. at least one de novo lesion in a small vessel (\>2.00 mm and ≤3.00). Vessel size is evaluated by visual estimation. It is possible to include only one study lesion per patient. For the purposes of this study, in cases of diffuse coronary artery disease where overlapped DCB are utilized for the treatment of the lesion, this will be considered as a single lesion. In case of a successful predilatation (i.e. no major (type D, E, F) angiographic dissections, residual stenosis ≤ 30% and TIMI flow = 3), the subject will be randomized in a 1:1 fashion to SelutionTM or SeQuent Please NeoTM. Randomization will be stratified according to DCB length (\< 30 mm or ≥ 30 mm) in order to include at least 100 patients treated with DCB of 30 mm or longer. Measurements of intramyocardial resistances, after lesion preparation prior to DCB treatment and after DCB treatment (2 measurements), will be limited to a maximum of 100 lesions treated with DCB ≥ 30 mm. Given the lack of literature data on intramyocardial resistance measurements, a minimum of 100 subjects is considered necessary to provide an initial evaluation of these parameters. With a total sample size of 140 patients for the study, it will be allowed to enroll up to 40 patients treated with DCB \< 30 mm. Once this limit is reached, only patients treated with DCB ≥ 30 mm will be enrolled while maintaining a 1:1 randomization ratio. During the index procedure, it is possible to treat other not study lesions (if applicable) with any other commercial device (e.g. drug-eluting stent) if they are located in a different epicardial territory than the study target lesion. All not studylesions should be treated prior to study target lesion procedure, and should be successful and uncomplicated. Follow-up by phone call will occur at 1 and 6 months post-PCI. At 12 months all subjects will perform an angiographic follow up at the same site where the index procedure was performed. Quantitative Coronary Angiography (QCA) assessment will be performed at baseline (pre- and post-procedure) and on follow up angiography by the imaging core lab. FFR assessment will be performed at the time of follow-up angiography. All subjects must receive dual anti-platelet therapy (DAPT), being aspirin (ASA) and P2Y12 inhibition therapy for at least 1 month after drug coated balloon PCI or according to standard local practice (with the choice of agent left to the discretion of the investigator), followed by ASA monotherapy indefinitely. However, in case the subject had recent ACS or is receiving additional drug-eluting stents, DAPT must be given according to local standard of care.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
140
PCI treatment with DCB, in particular sirolimus coated balloon
PCI treatment with DCB, in particular paclitaxel coated balloon
Clinica Montevergine
Mercogliano, Italy/Avellino, Italy
RECRUITINGASST Papa Giovanni XXIII
Bergamo, Italy/Bergamo, Italy
RECRUITINGFondazione Poliambulanza
Brescia, Italy/Brescia, Italy
RECRUITINGAzienda Ospedaliero Universitaria di Ferrara
Ferrara, Italy/Ferrara, Italy
WITHDRAWNCentro Cardiologico Monzino
Milan, Italy/Milano, Italy
RECRUITINGIstituto Clinico Humanitas
Rozzano, Italy/Milano, Italy
RECRUITINGClinica Mediterranea
Napoli, Italy/Napoli, Italy
RECRUITINGAzienda Ospedaliero Universitaria San Luigi Gonzaga
Orbassano, Italy/Torino, Italy
RECRUITINGOspedale di Rivoli
Rivoli, Italy/Torino, Italy
RECRUITINGOspedale Sant'Andrea
Vercelli, Italy/Vercelli, Italy
NOT_YET_RECRUITINGIn-segment (balloon treated area) Net Gain (mm) at 12 months post-procedure
The primary endpoint is in-segment (balloon treated area) Net Gain (mm) at 12 months post-procedure. Net Gain is defined as acute gain at the time of the index procedure minus late loss at the time of follow-up angiography.
Time frame: 12 months post-procedure
Fractional Flow Reserve (FFR)
FFR (absolute value) at 12 months post-procedure
Time frame: From enrollment to the end of treatment at 12 months
Device success (lesion based)
Successful delivery and inflation within 45 seconds of the allocated DCB device at the intended target lesion during an attempt with a DCB not previously used (first use) and successful withdrawal of the device system with attainment of final in-lesion residual stenosis of \<30%. I
Time frame: 12 months post-procedure
Procedure success
Successful delivery and inflation within 45 seconds of the allocated DCB device at the intended target lesion during an attempt with a DCB not previously used (first use) and successful withdrawal of the device system with attainment of final in-lesion residual stenosis of \<30 % without the occurrence of TLF during the index procedure hospital stay).
Time frame: 12 months post-procedure
Angiographic outcomes 1
late lumen loss
Time frame: 12 months post-procedure
Angiographic outcomes 2
minimal lumen diameter
Time frame: 12 months post-procedure
Angiographic outcomes 3
percent diameter stenosis
Time frame: 12 months post-procedure
Angiographic outcomes 4
restenosis rate
Time frame: 12 months post-procedure
Device oriented Composite Endpoint (DoCE/ TLF)
DoCE/ TLF which is composite of cardiac death, TV-MI, and clinically indicated target lesion revascularization (TLR)
Time frame: 12 months post-procedure
Acute/subacute/early/late vessel thrombosis
Thrombosis should be reported as a cumulative value at the different time points and with the different separate time points. Time 0 is defined as the time point after the guiding catheter has been removed and the patient left the catheterization lab.
Time frame: 12 months post-procedure
Periprocedural myocardial infarction
Periprocedural myocardial infarction according to the Fourth Universal definition of Myocardial Infarction
Time frame: From enrollment to the end of treatment at 12 months
PCI related myocardial injury
PCI related myocardial injury, defined according to the Fourth Universal definition of Myocardial Infarction estimating the absolute value of troponin pre-discharge or within 3-8 hours post-PCI
Time frame: From enrollment to the end of treatment at 12 months
Absolute difference in CFR for the first 100 patients treated with DCB ≥ 30 mm
Absolute difference in CFR measured with a dedicated system (PressureWire™ X Guidewire and Coroventis CoroFlow Cardiovascular System, Abbott)
Time frame: baseline
Absolute variation in IMR for the first 100 patients treated with DCB ≥ 30 mm
Absolute variation in IMR from the first assessment (after predilation) to the second assessment (after DCB angioplasty)
Time frame: baseline
Absolute decrease in CFR for the first 100 patients treated with DCB ≥ 30 mm
Absolute decrease in CFR from the first assessment (after predilatation) to the second assessment (after DCB angioplasty)
Time frame: baseline
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