SPAGO: Sirolimus Paclitaxel Angiographic Gain Objective

Coronary Artery Disease Clinical Trial

— SPAGO  

Official title:

Selution Sirolimus Coated Balloon (MedAlliance) Versus SeQuent Please Neo Paclitaxel Coated Balloon (Bbraun) for the Treatment of de Novo Coronary Artery Lesions in Medium-small Size Vessels.

Clinical Trial Details — Status: Not yet recruiting

Administrative data

• NCT number: NCT06373601
• Other study ID #: SPAGO
• Status: Not yet recruiting
• Phase: N/A
• Start date: July 1, 2024
• Est. completion date: February 1, 2027

Study information

• Verified date: April 2024
• Source: Fondazione Evidence per Attività e Ricerche Cardiovascolari ONLUS
• Contact: Marina Cornacchia Schenetti
• Phone: 03761810406
• Email: schema1950[@]gmail.com
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

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) at 12 months follow-up.

Description:

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 more than one study lesion even if they are located in the same vessel. In case of a successful pre-dilatation (i.e. no major (type D, E, F) angiographic dissections, residual stenosis ≤ 30% and TIMI flow ≥ 2), the subject will be randomized in a 1:1 fashion to Selution or SeQuent Please Neo. If the Investigator decides to include more than one study lesion for the same subject, all the lesions must be successful pre-dilatated and must be treated following the assigned treatment by randomization.

Other not study lesions (if applicable) can be treated with any other commercial device (e.g. drug-eluting stent). All not study lesions 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.

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.

Recruitment information / eligibility

• Status: Not yet recruiting
• Enrollment: 120
• Est. completion date: February 1, 2027
• Est. primary completion date: February 1, 2027
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

1. Male or female subjects =18 years

2. Subject with chronic stable angina or stabilized acute coronary syndromes with normal cardiac biomarker values.

3. The subject has at least one de-novo lesion in a small vessel (>2.00 mm and =3.00 mm prior to pre-dilatation) with a diameter stenosis = 50% (prior to pre-dilatation). It is possible to enroll subjects that have a stent previously implanted in the same epicardial territory (main vessel and ramifications) of the target lesion

4. Target lesion length =35 mm

5. Able to understand and provide informed consent and comply with all study procedures including 12 months angiographic follow-up

6. Subject must have completed the follow-up phase of any previous study

Exclusion Criteria:

1. Subject is a woman who is pregnant or nursing (a pregnancy test must be performed within 7 days prior to the index procedure in women of child-bearing potential)

2. Evidence of ongoing acute myocardial infarction (AMI) in ECG and/or elevated cardiac biomarkers (according to local standard hospital practice) have not returned within normal limits at the time of procedure

3. Known contraindication or hypersensitivity to sirolimus, paclitaxel, or to medications such as aspirin, heparin, and all of the following four medications: clopidogrel bisulfate, ticlopidine, prasugrel, ticagrelor

4. Subjects who experienced a previous PCI with DCB in the epicardial territory (main vessel and ramifications) where the target lesion is located, during the last 12 months

5. Subject suffered from stroke/TIA during the last 6 months

6. LVEF <30%

7. Platelet count <100,000 cells/mm3 or >400,000 cells/mm3, a WBC of <3,000 cells/mm3, or documented or suspected liver disease (including laboratory evidence of hepatitis)

8. Known renal insufficiency (e.g. serum creatinine >2,5 mg/dL, creatinine clearance =30 mL/min or eGFR =30 mL/min/m2), or subject on dialysis, or acute kidney failure (as per physician judgment)

9. Subject undergoing planned surgery within 1 month with the necessity to stop DAPT

10. History of bleeding diathesis or coagulopathy

11. The subject is a recipient of a heart transplant

12. Concurrent medical condition with a life expectancy of less than 12 months

13. The subject is unwilling/not able to return for angiographic re-catheterisation at 12 months follow-up

14. Currently participating in another trial

Angiographic exclusion criteria:

15. Target vessel size >3.00 mm

16. Target vessel size =2.00 mm

17. Target lesion has a diameter stenosis < 50% prior to pre-dilatation

18. Target lesion has a total occlusion or TIMI flow < 2 prior to pre-dilatation

19. Pre-dilatation of the target lesion not performed or not successful (residual stenosis > 30%, TIMI flow < 3 and presence of major angiographic dissections)

20. Target lesion in left main stem

21. The target vessel contains visible thrombus

22. Aorto-ostial target lesion (within 3 mm of the aorta junction)

23. Lesion is located within an arterial or saphenous vein graft or distal to a diseased arterial or saphenous vein graft

Related Conditions & MeSH terms

• Coronary Artery Disease
• Coronary Artery Lesion
• Coronary Stenosis
• Percutaneous Coronary Intervention

Intervention

Device:
• sirolimus-eluting balloon (Selution)
PCI treatment with DCB, in particular sirolimus coated balloon
• paclitaxel-eluting balloon (SeQuent Please Neo)
PCI treatment with DCB, in particular paclitaxel coated balloon

Locations

Country	Name	City	State
n/a

Sponsors (1)

Lead Sponsor	Collaborator
Fondazione Evidence per Attività e Ricerche Cardiovascolari ONLUS

References & Publications (33)

Bohme T, Noory E, Beschorner U, Macharzina R, Zeller T. The SELUTION SLR drug-eluting balloon system for the treatment of symptomatic femoropopliteal lesions. Future Cardiol. 2021 Mar;17(2):257-267. doi: 10.2217/fca-2020-0085. Epub 2020 Aug 20. — View Citation

Capodanno D, Angiolillo DJ. Timing, Selection, Modulation, and Duration of P2Y12 Inhibitors for Patients With Acute Coronary Syndromes Undergoing PCI. JACC Cardiovasc Interv. 2023 Jan 9;16(1):1-18. doi: 10.1016/j.jcin.2022.10.023. — View Citation

Com-Nougue C, Rodary C, Patte C. How to establish equivalence when data are censored: a randomized trial of treatments for B non-Hodgkin lymphoma. Stat Med. 1993 Jul 30;12(14):1353-64. doi: 10.1002/sim.4780121407. — View Citation

Cortese B, Bertoletti A. Paclitaxel coated balloons for coronary artery interventions: a comprehensive review of preclinical and clinical data. Int J Cardiol. 2012 Nov 1;161(1):4-12. doi: 10.1016/j.ijcard.2011.08.855. Epub 2011 Sep 28. — View Citation

Cortese B, Micheli A, Picchi A, Coppolaro A, Bandinelli L, Severi S, Limbruno U. Paclitaxel-coated balloon versus drug-eluting stent during PCI of small coronary vessels, a prospective randomised clinical trial. The PICCOLETO study. Heart. 2010 Aug;96(16):1291-6. doi: 10.1136/hrt.2010.195057. — View Citation

Costa RA, Mandal SC, Hazra PK, Chopda M, Chandra P, Damiani LP, Abizaid A, Hiremath S. Sirolimus-Coated Balloon With a Microsphere-Based Technology for the Treatment of De Novo or Restenotic Coronary Lesions. Cardiovasc Revasc Med. 2022 Dec;45:18-25. doi: 10.1016/j.carrev.2022.08.037. Epub 2022 Sep 5. — View Citation

Cutlip DE, Windecker S, Mehran R, Boam A, Cohen DJ, van Es GA, Steg PG, Morel MA, Mauri L, Vranckx P, McFadden E, Lansky A, Hamon M, Krucoff MW, Serruys PW; Academic Research Consortium. Clinical end points in coronary stent trials: a case for standardized definitions. Circulation. 2007 May 1;115(17):2344-51. doi: 10.1161/CIRCULATIONAHA.106.685313. — View Citation

Garcia-Garcia HM, McFadden EP, Farb A, Mehran R, Stone GW, Spertus J, Onuma Y, Morel MA, van Es GA, Zuckerman B, Fearon WF, Taggart D, Kappetein AP, Krucoff MW, Vranckx P, Windecker S, Cutlip D, Serruys PW; Academic Research Consortium. Standardized End Point Definitions for Coronary Intervention Trials: The Academic Research Consortium-2 Consensus Document. Circulation. 2018 Jun 12;137(24):2635-2650. doi: 10.1161/CIRCULATIONAHA.117.029289. — View Citation

Hicks KA, Stockbridge NL, Targum SL, Temple RJ. Bleeding Academic Research Consortium consensus report: the Food and Drug Administration perspective. Circulation. 2011 Jun 14;123(23):2664-5. doi: 10.1161/CIRCULATIONAHA.111.032433. No abstract available. — View Citation

Jeger RV, Eccleshall S, Wan Ahmad WA, Ge J, Poerner TC, Shin ES, Alfonso F, Latib A, Ong PJ, Rissanen TT, Saucedo J, Scheller B, Kleber FX; International DCB Consensus Group. Drug-Coated Balloons for Coronary Artery Disease: Third Report of the International DCB Consensus Group. JACC Cardiovasc Interv. 2020 Jun 22;13(12):1391-1402. doi: 10.1016/j.jcin.2020.02.043. Epub 2020 May 27. — View Citation

Jeger RV, Farah A, Ohlow MA, Mangner N, Mobius-Winkler S, Leibundgut G, Weilenmann D, Wohrle J, Richter S, Schreiber M, Mahfoud F, Linke A, Stephan FP, Mueller C, Rickenbacher P, Coslovsky M, Gilgen N, Osswald S, Kaiser C, Scheller B; BASKET-SMALL 2 Investigators. Drug-coated balloons for small coronary artery disease (BASKET-SMALL 2): an open-label randomised non-inferiority trial. Lancet. 2018 Sep 8;392(10150):849-856. doi: 10.1016/S0140-6736(18)31719-7. Epub 2018 Aug 28. — View Citation

Katsanos K, Spiliopoulos S, Kitrou P, Krokidis M, Karnabatidis D. Risk of Death Following Application of Paclitaxel-Coated Balloons and Stents in the Femoropopliteal Artery of the Leg: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Am Heart Assoc. 2018 Dec 18;7(24):e011245. doi: 10.1161/JAHA.118.011245. — View Citation

Kloner RA, Dai W. Glycoprotein IIb/IIIa inhibitors and no-reflow. J Am Coll Cardiol. 2004 Jan 21;43(2):284-6. doi: 10.1016/j.jacc.2003.11.005. No abstract available. — View Citation

Kufner S, Ernst M, Cassese S, Joner M, Mayer K, Colleran R, Koppara T, Xhepa E, Koch T, Wiebe J, Ibrahim T, Fusaro M, Laugwitz KL, Schunkert H, Kastrati A, Byrne RA; ISAR-TEST-5 Investigators. 10-Year Outcomes From a Randomized Trial of Polymer-Free Versus Durable Polymer Drug-Eluting Coronary Stents. J Am Coll Cardiol. 2020 Jul 14;76(2):146-158. doi: 10.1016/j.jacc.2020.05.026. — View Citation

Lassen JF, Burzotta F, Banning AP, Lefevre T, Darremont O, Hildick-Smith D, Chieffo A, Pan M, Holm NR, Louvard Y, Stankovic G. Percutaneous coronary intervention for the left main stem and other bifurcation lesions: 12th consensus document from the European Bifurcation Club. EuroIntervention. 2018 Jan 20;13(13):1540-1553. doi: 10.4244/EIJ-D-17-00622. — View Citation

Latib A, Colombo A, Castriota F, Micari A, Cremonesi A, De Felice F, Marchese A, Tespili M, Presbitero P, Sgueglia GA, Buffoli F, Tamburino C, Varbella F, Menozzi A. A randomized multicenter study comparing a paclitaxel drug-eluting balloon with a paclitaxel-eluting stent in small coronary vessels: the BELLO (Balloon Elution and Late Loss Optimization) study. J Am Coll Cardiol. 2012 Dec 18;60(24):2473-80. doi: 10.1016/j.jacc.2012.09.020. Epub 2012 Nov 14. Erratum In: J Am Coll Cardiol. 2013 Apr 16;61(15):1660. — View Citation

Latib A, Ruparelia N, Menozzi A, Castriota F, Micari A, Cremonesi A, De Felice F, Marchese A, Tespili M, Presbitero P, Sgueglia GA, Buffoli F, Tamburino C, Varbella F, Colombo A. 3-Year Follow-Up of the Balloon Elution and Late Loss Optimization Study (BELLO). JACC Cardiovasc Interv. 2015 Jul;8(8):1132-1134. doi: 10.1016/j.jcin.2015.04.008. No abstract available. — View Citation

Madanchi M, Cioffi GM, Attinger-Toller A, Seiler T, Somm S, Koch T, Tersalvi G, Wolfrum M, Moccetti F, Toggweiler S, Kobza R, Levine MB, Garcia-Garcia HM, Bossard M, Cuculi F. Metal free percutaneous coronary interventions in all-comers: First experience with a novel sirolimus-coated balloon. Cardiol J. 2022;29(6):906-916. doi: 10.5603/CJ.a2022.0106. Epub 2022 Nov 17. — View Citation

Madhavan MV, Kirtane AJ, Redfors B, Genereux P, Ben-Yehuda O, Palmerini T, Benedetto U, Biondi-Zoccai G, Smits PC, von Birgelen C, Mehran R, McAndrew T, Serruys PW, Leon MB, Pocock SJ, Stone GW. Stent-Related Adverse Events >1 Year After Percutaneous Coronary Intervention. J Am Coll Cardiol. 2020 Feb 18;75(6):590-604. doi: 10.1016/j.jacc.2019.11.058. — View Citation

Mehilli J, Dibra A, Kastrati A, Pache J, Dirschinger J, Schomig A; Intracoronary Drug-Eluting Stenting to Abrogate Restenosis in Small Arteries (ISAR-SMART 3) Study Investigators. Randomized trial of paclitaxel- and sirolimus-eluting stents in small coronary vessels. Eur Heart J. 2006 Feb;27(3):260-6. doi: 10.1093/eurheartj/ehi721. Epub 2006 Jan 9. — View Citation

Moussa ID, Klein LW, Shah B, Mehran R, Mack MJ, Brilakis ES, Reilly JP, Zoghbi G, Holper E, Stone GW. Consideration of a new definition of clinically relevant myocardial infarction after coronary revascularization: an expert consensus document from the Society for Cardiovascular Angiography and Interventions (SCAI). J Am Coll Cardiol. 2013 Oct 22;62(17):1563-70. doi: 10.1016/j.jacc.2013.08.720. — View Citation

Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Juni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferovic PM, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO; ESC Scientific Document Group. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019 Jan 7;40(2):87-165. doi: 10.1093/eurheartj/ehy394. No abstract available. Erratum In: Eur Heart J. 2019 Oct 1;40(37):3096. — View Citation

Park KH, Park SW, Hong MK, Kim YH, Lee BK, Park DW, Choi BR, Kim MJ, Park KM, Lee CW, Cheong SS, Kim JJ, Park SJ. Comparison of the effectiveness of sirolimus- and paclitaxel-eluting stents for small coronary artery lesions. Catheter Cardiovasc Interv. 2006 Apr;67(4):589-94. doi: 10.1002/ccd.20700. — View Citation

Rezkalla SH, Stankowski RV, Hanna J, Kloner RA. Management of No-Reflow Phenomenon in the Catheterization Laboratory. JACC Cardiovasc Interv. 2017 Feb 13;10(3):215-223. doi: 10.1016/j.jcin.2016.11.059. Erratum In: JACC Cardiovasc Interv. 2017 Jun 26;10(12):1282. — View Citation

Scheller B, Speck U, Abramjuk C, Bernhardt U, Bohm M, Nickenig G. Paclitaxel balloon coating, a novel method for prevention and therapy of restenosis. Circulation. 2004 Aug 17;110(7):810-4. doi: 10.1161/01.CIR.0000138929.71660.E0. Epub 2004 Aug 9. — View Citation

Spaulding C, Krackhardt F, Bogaerts K, Urban P, Meis S, Morice MC, Eccleshall S. Comparing a strategy of sirolimus-eluting balloon treatment to drug-eluting stent implantation in de novo coronary lesions in all-comers: Design and rationale of the SELUTION DeNovo Trial. Am Heart J. 2023 Apr;258:77-84. doi: 10.1016/j.ahj.2023.01.007. Epub 2023 Jan 13. — View Citation

Tang Y, Qiao S, Su X, Chen Y, Jin Z, Chen H, Xu B, Kong X, Pang W, Liu Y, Yu Z, Li X, Li H, Zhao Y, Wang Y, Li W, Tian J, Guan C, Xu B, Gao R; RESTORE SVD China Investigators. Drug-Coated Balloon Versus Drug-Eluting Stent for Small-Vessel Disease: The RESTORE SVD China Randomized Trial. JACC Cardiovasc Interv. 2018 Dec 10;11(23):2381-2392. doi: 10.1016/j.jcin.2018.09.009. — View Citation

Tanimoto S, Daemen J, Tsuchida K, Garcia-Garcia HM, de Jaegere P, van Domburg RT, Serruys PW. Two-year clinical outcome after coronary stenting of small vessels using 2.25-mm sirolimus- and paclitaxel-eluting stents: insight into the RESEARCH and T-SEARCH registries. Catheter Cardiovasc Interv. 2007 Jan;69(1):94-103. doi: 10.1002/ccd.20907. — View Citation

Thygesen K. 'Ten Commandments' for the Fourth Universal Definition of Myocardial Infarction 2018. Eur Heart J. 2019 Jan 14;40(3):226. doi: 10.1093/eurheartj/ehy856. No abstract available. — View Citation

Togni M, Eber S, Widmer J, Billinger M, Wenaweser P, Cook S, Vogel R, Seiler C, Eberli FR, Maier W, Corti R, Roffi M, Luscher TF, Garachemani A, Hess OM, Wandel S, Meier B, Juni P, Windecker S. Impact of vessel size on outcome after implantation of sirolimus-eluting and paclitaxel-eluting stents: a subgroup analysis of the SIRTAX trial. J Am Coll Cardiol. 2007 Sep 18;50(12):1123-31. doi: 10.1016/j.jacc.2007.06.015. Epub 2007 Sep 4. — View Citation

Unverdorben M, Kleber FX, Heuer H, Figulla HR, Vallbracht C, Leschke M, Cremers B, Hardt S, Buerke M, Ackermann H, Boxberger M, Degenhardt R, Scheller B. Treatment of small coronary arteries with a paclitaxel-coated balloon catheter in the PEPCAD I study: are lesions clinically stable from 12 to 36 months? EuroIntervention. 2013 Sep;9(5):620-8. doi: 10.4244/EIJV9I5A99. — View Citation

Wohrle J. Drug-coated balloons for coronary and peripheral interventional procedures. Curr Cardiol Rep. 2012 Oct;14(5):635-41. doi: 10.1007/s11886-012-0290-x. — View Citation

Zhang X, Wang Q, Wang X, Xu X, Zhu J. [Comparison of limus-eluting stent with paclitaxel-eluting stent for patients with coronary small vessel disease:a systematic review and meta-analysis]. Zhejiang Da Xue Xue Bao Yi Xue Ban. 2017 May 25;46(3):305-314. doi: 10.3785/j.issn.1008-9292.2017.06.14. Chinese. — View Citation

* Note: There are 33 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	In-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.	12 months post-procedure
Secondary	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	12 months post-procedure
Secondary	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).	12 months post-procedure
Secondary	Angiographic outcomes 1	late lumen loss	12 months post-procedure
Secondary	Angiographic outcomes 2	minimal lumen diameter	12 months post-procedure
Secondary	Angiographic outcomes 3	percent diameter stenosis	12 months post-procedure
Secondary	Angiographic outcomes 4	restenosis rate	12 months post-procedure
Secondary	Device oriented Composite Endpoint (DoCE/ TLF)	DoCE/ TLF which is composite of cardiac death, TV-MI, and clinically indicated target lesion revascularization (TLR)	12 months post-procedure
Secondary	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.	12 months post-procedure

External Links

•   Non-Inferiority Clinical Trials
•   SELUTION SLR™ 014 In-stent Restenosis