Extracorporeal Shockwave Therapy for the Treatment of Advanced Angina Pectoris - Full Text View

Purpose

Low intensity shockwaves have been proven in animal studies to induce local growth of new blood vessels from existing ones.

The hypothesis of this study is that shockwave therapy could improve the symptoms of patients with refractory angina not amenable to revascularization with angioplasty or bypass surgery.

Condition	Intervention	Phase
Refractory Angina Pectoris	Device: Cardiac Extracorporeal Shockwave Therapy generator (Cardiospec)	Phase 1

Study Type:	Interventional
Study Design:	Allocation: Non-Randomized Endpoint Classification: Safety/Efficacy Study Intervention Model: Single Group Assignment Masking: Open Label Primary Purpose: Treatment
Official Title:	Shockwave Treatment for Advanced Angina in Maastricht (SWAAM). A Pilot Study

Resource links provided by NLM:

MedlinePlus related topics: Angina

U.S. FDA Resources

Further study details as provided by Medispec:

Primary Outcome Measures:

Time to Angina [ Time Frame: 6 months ] [ Designated as safety issue: No ]
Change in time to angina using the modified Bruce exercise test from baseline to the 6 months post baseline assessment

Secondary Outcome Measures:

Change in SPECT [ Time Frame: 6 months ] [ Designated as safety issue: No ]
The change in perfusion in pharmacological induced stress SPECT test (at rest and at stress) from baseline to 6 months post baseline (17 segment model)
Change in AP-CCS [ Time Frame: 6 months ] [ Designated as safety issue: No ]
The AP-CCS stage at the 6 months post baseline.
Total Exercise time [ Time Frame: 6 months ] [ Designated as safety issue: No ]
The change in total exercise time (Exercise Tolerance Test- ETT) from baseline to 6 months post baseline.
Number of Angina attacks (patient diary) [ Time Frame: 6 months ] [ Designated as safety issue: No ]
The change in the number of angina attacks from baseline to 6 months post baseline. The number of attacks per week will be documented.

Enrollment:	33
Study Start Date:	January 2009
Study Completion Date:	June 2012
Primary Completion Date:	January 2012 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Experimental: A Treatment group. Patients in this group receive actual shockwave therapy.	Device: Cardiac Extracorporeal Shockwave Therapy generator (Cardiospec) Energy Density - 0.09 mJ/mm2 Other Names: Cardiospec ESMR therapy Extracorporeal Shockwave Myocardial Revascularization

Detailed Description:

Low intensity shockwaves (1/10 the ones used in Lithotripsy) are delivered to myocardial ischemic tissue. Shockwaves are created by a special generator and are focused using a shockwave applicator device. The treatment is guided by standard echocardiography equipment. The shockwaves are delivered in synchronization with Patient R-wave to avoid arrhythmias. The treatment is painless.

At first, the patient undergoes stress-SPECT testing to identify the ischemic areas. Following that, the same area is localized by the ultra-sound device and the shockwaves are focused to the ischemic area. Several treatment session (9 in total, spread over 9 weeks) are required for optimal results.

Eligibility

Ages Eligible for Study:	18 Years and older
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Patient is diagnosed with chronic stable angina pectoris, for a period of at least 3 months. Diagnosis is based on medical history, complete physical evaluation.
Patient has documented myocardial segments with reversible ischemia.
Patient is classified in AP CCS of III-IV.
Patient should be on a stable dosage of medication used to treat angina for at least 6 weeks prior to enrollment.
Patient demonstrates exercise tolerance capacity of no higher than 125 W on a modified Bruce treadmill exercise test until presence of clinical symptoms (i.e. angina, ST-depression).
Patient demonstrates exercise tolerance time and stability averaging no more than 25% of each other (the tests will be performed within two weeks and at least a day different between the two).
Patient has documented epicardial coronary artery disease not amenable to angioplasty or CABG.
Patient has signed an IRB approved informed consent form.
Patient's condition should be stable and should have a life expectancy of >12 months. Patient's current and past medical condition and status will be assessed using previous medical history, physical evaluation, and the physicians (principle investigator's) medical opinion.

Exclusion Criteria:

Patient is pregnant
Patient has chronic lung disease including emphysema and pulmonary fibrosis.
Patient has active endocarditis, myocarditis or pericarditis.
Patient is simultaneously participating in another device or drug study, or has participated in any clinical trial involving an experimental device or drug, including other drugs or devices enhancing cardiac neovascularization, or any ESWT machine of a competitor company within 3 months of entry into the study.
Patients who are unwilling or unable to cooperate with study procedure

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT01219218

Locations

Netherlands
Academisch Ziekenhuis Maastricht
Maastricht, Netherlands

Sponsors and Collaborators

Medispec

Academisch Ziekenhuis Maastricht

Investigators

Principal Investigator:

Prof. Johannes Waltenberger, MD, PhD

Academisch Ziekenhuis Maastricht

More Information

No publications provided

Responsible Party:	Medispec
ClinicalTrials.gov Identifier:	NCT01219218 History of Changes
Other Study ID Numbers:	ESMR-AZM-NL
Study First Received:	October 10, 2010
Last Updated:	February 17, 2013
Health Authority:	Netherlands: Independent Ethics Committee

Keywords provided by Medispec:

Extracorporeal Shockwave Therapy
Myocardial Ischemia
Refractory Angina

Additional relevant MeSH terms:

Angina Pectoris
Myocardial Ischemia
Heart Diseases
Cardiovascular Diseases

Vascular Diseases
Chest Pain
Pain
Signs and Symptoms

ClinicalTrials.gov processed this record on May 16, 2013