IonMAN Trial- First in Human Study of the IoNIR Ridaforolimus-Eluting Coronary Stent System

Inclusion Criteria:

1. Age ≥18 years.

2. Patient with an indication for PCI including NSTEMI (biomarkers have peaked or arefalling), angina (stable or unstable), silent ischemia (in absence of symptoms avisually estimated target lesion diameter stenosis of ≥70%, a positive non-invasivestress test, or FFR ≤0.80, Pd/Pa≤0.91or iFR, RFR, DFR, DPR≤0.89 must be present).

3. Non-target vessel PCIs are allowed if performed >30 days prior to index procedure.

4. Patient or legal guardian is willing and able to provide informed written consentand comply with follow-up visits and testing schedule.

5. Staged procedures are allowed as long as the IoNIR stent is implanted in the lastprocedure and at least 30 days have elapsed between the previous procedure and theIoNIR PCI.

6. One de novo target lesion ONLY may be treated (more than one lesion separated byless than 5 mm are considered one lesion).

7. Target lesion must be in a major native coronary artery with visually estimateddiameter of ≥2.5 mm to ≤4.0 mm and lesion length of up to 28 mm, and appropriatesize IoNIR stent is available

Exclusion Criteria:

1. ST Segment Elevation MI within past 30 days.

2. NSTEMI with biomarkers that have not peaked.

3. Significant valvular disease or planned valvular intervention.

4. PCI within the 30 days preceding the baseline procedure.

5. PCI in the target vessel within 12 months of the baseline procedure.

6. Planned staged procedures (coronary or valvular), where the study stent is implantedin the first stage.

7. Brachytherapy in conjunction with the baseline procedure.

8. Known history of stent thrombosis.

9. Cardiogenic shock (defined as persistent hypotension (systolic blood pressure <90mm/Hg for more than 30 minutes) or requiring pressors or hemodynamic support,including IABP.

10. Subject is intubated.

11. Known LVEF <30%.

12. Relative or absolute contraindication to DAPT for 6 months in non-ACS patients and 12 months in ACS patients (including planned surgeries that cannot be delayed).

13. Subject has an indication such as atrial fibrillation for oralanticoagulation/prolonged heparinization (i.e., use of coumadin/DOAC (NOAC) orprolonged enoxaparin/heparin therapy is not allowed).

14. eGFR <60 mL/min.

15. Hemoglobin <10 g/dL.

16. Platelet count <100,000 cells/mm3 or >700,000 cells/mm3.

17. White blood cell (WBC) count <3,000 cells/mm3.

18. Clinically significant liver disease.

19. Active peptic ulcer or active bleeding from any site

20. Bleeding from any site within the previous 8 weeks requiring active medical orsurgical attention.

21. If femoral access is planned, significant peripheral arterial disease whichprecludes safe insertion of a 6F sheath.

22. History of bleeding diathesis or coagulopathy and patients that refuse bloodtransfusions.

23. Cerebrovascular accident or transient ischemic attack within the past 6 months, orany permanent neurologic defect attributed to CVA.

24. Known allergy to the study stent components (cobalt, nickel, chromium, molybdenum,PDLG, PLC, or limus drugs (ridaforolimus, zotarolimus, tacrolimus, sirolimus,everolimus, or similar drugs or any other analogue or derivative or similarcompounds).

25. Known allergy to protocol-required concomitant medications such as aspirin, or P2Y12inhibitors (clopidogrel, prasugrel, and ticagrelor), heparin and bivalirudin, oriodinated contrast allergy that cannot be adequately pre-medicated.

26. Any co-morbid condition that may cause non-compliance with the protocol (e.g.,dementia, substance abuse, etc.) or reduced life expectancy to <24 months (e.g.,cancer, severe heart failure, severe lung disease).

27. Patient is participating in or plans to participate in any other investigationaldrug or device clinical trial that has not reached its primary endpoint.

28. Women who are pregnant or breastfeeding.

29. Women who intend to become pregnant within 12 months after the baseline procedure (women of child-bearing potential who are sexually active must agree to use areliable method of contraception from the time of screening through 12 months afterthe baseline procedure).

30. Patient has received an organ transplant or is on a waiting list for an organtransplant.

31. Patient is receiving or scheduled to receive chemotherapy within 30 days before orany time after the baseline procedure.

32. Patient is receiving oral or intravenous immunosuppressive therapy or has knownlife-limiting immunosuppressive or autoimmune disease (e.g., HIV). Corticosteroidsare allowed

33. More than one lesion of greater than 50% stenosis in the target vessel.

34. Complex lesions including severely calcified lesions, lesions requiringscoring/cutting and/or rotational/orbital atherectomy and/or intra-vascularlithotripsy, presence of visible thrombus, chronic total occlusions, bifurcationlesions (side branch diameter ≥2.0 mm), tortuous lesions, restenotic lesions, leftmain lesions, ectasia, aneurysm and any bypass graft lesions.

35. Another lesion in a target or non-target vessel (including all side branches) ispresent that requires or has a high probability of requiring PCI within 12 monthsafter the baseline procedure.

36. Ostial lesions within 3 mm of LAD, LCx, RCA ostia, lesions in the LM