Safety and Efficacy of Low Temperature Rota-flush Solution in Patients With Severe Calcified Lesion (LOTA-II)

  • STATUS
    Recruiting
  • End date
    Dec 1, 2021
  • participants needed
    110
  • sponsor
    Nanjing First Hospital, Nanjing Medical University
Updated on 25 January 2021
troponin
single coronary artery

Summary

Calcified lesions related to coronary artery are a type of atherosclerosis, accompanied by severe calcified lesions of the stenosis, which is a difficult point for PCI interventional therapy. Calcified lesions have poor response to balloon dilatation and the device can not be successfully placed, which reduce the success rate of operation. Furthermore, the stent is under-expanded and the adherence is poor, which significantly increases the incidence of major adverse cardiovascular events (MACEs).

Intracoronary rotational atherectomy (RA) was developed by David Auth in the early 1980s. In 1988, Bertrand has completed the first case of coronary RA. RA was recommended for treatment of severe calcified lesions in ACC/AHA Guidelines for Coronary Interventional Therapy in 2011 (IIa, C). However, many studies have found that the incidence of RA-related myocardial injury is relatively high, and affect the efficacy of RA and prognosis in patients with severe calcified lesions. It has been reported that 58 consecutive patients with stable angina requiring PCI with RA to a calcified coronary lesion have 68% 5-fold increase in high sensitivity troponin after RA. The objective of this randomized control trial is to gain a clinical insight on the use of low temperature rota-flush solution for the treatment of RA-related myocardial injury in patients with heavy calcified lesions. The primary objective is assess efficacy and safety of low temperature rota-flush solution for the treatment of RA-related myocardial injury in patients with severe calcified lesions.

Description

The current study is designed as a multicenter, randomized and prospective study aiming to compare the incidence rate of RA-related myocardial injury indicated by change in levels of myocardial injury biomarkers (such as TNI and CK-MB) between low temperature rota-flush solution group and room temperature rota-flush solution group. Based on previous study, the incidence rate of RA-related myocardial injury is 68.0 % in patients with severe calcified lesions undergoing PCI. And in our study the expected incidence rate of RA-related myocardial injury is up to 34.0 % in patients with severe calcified lesions undergoing PCI after treatment with low temperature rota-flush solution. Moreover, the investigators estimated 10% loss follow-up of these patients in each arm. As a result, a total of 110 patients with heavy calcified lesions were required, and with 55 patients per group as a ratio of 1:1 randomization.

Details
Condition Myocardial Injury
Treatment low temperature rota-flush solution
Clinical Study IdentifierNCT03701230
SponsorNanjing First Hospital, Nanjing Medical University
Last Modified on25 January 2021

Eligibility

Yes No Not Sure

Inclusion Criteria

Is your age greater than or equal to 18 yrs?
Gender: Male or Female
Do you have Myocardial Injury?
Do you have any of these conditions: Do you have Myocardial Injury??
De novo lesions
Severe coronary calcified lesion (detected by CAG, IVUS or OCT)
New generation drug eluting stent implantation
Only single coronary artery treated at this time

Exclusion Criteria

Those who meet the diagnostic criteria of acute myocardial infarction
Patients with cardio-genic shock
Patients with multiple organ failure
Patients allergic to contrast
Patients who can not tolerate dual antiplatelet therapy
Patients who can't tolerate anticoagulation
Recently infected patients
Patients with hepatorenal dysfunction
Thrombotic lesion of coronary artery
Spontaneous coronary dissection
Patients with drug coated balloon treatment
Patients with bioabsorbable vascular scaffold implantation
Previous percutaneous coronary intervention
Patients with active stage of autoimmune disease
Patients with complex coronary bifurcation requiring two stent strategy
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