Boston Scientific Embolic Protection, Inc. (EPI): A Carotid Stenting Trial for High-Risk Surgical Patients (BEACH) - Full Text View

Sponsor:	Boston Scientific Corporation
Information provided by:	Boston Scientific Corporation
ClinicalTrials.gov Identifier:	NCT00316108

Purpose

The purpose of this study is to determine whether morbidity and mortality for high-risk surgical patients treated with the Carotid Wallstent in conjunction with the FilterWire EX and EZ System distal protection device will be less than or equal to that of objective performance criteria (OPC) derived from historic controls undergoing surgical intervention with a carotid endarterectomy (CEA).

Condition	Intervention
Carotid Artery Diseases Stroke Cerebral Arteriosclerosis	Device: WALLSTENT® Endoprosthesis™

Study Type:	Interventional
Study Design:	Treatment, Non-Randomized, Open Label, Historical Control, Single Group Assignment, Safety/Efficacy Study
Official Title:	Boston Scientific EPI: A Carotid Stenting Trial for High-Risk Surgical Patients

Resource links provided by NLM:

MedlinePlus related topics: Carotid Artery Disease Heart Attack Surgery

U.S. FDA Resources

Further study details as provided by Boston Scientific Corporation:

Primary Outcome Measures:

The primary endpoint is one-year morbidity and mortality, defined as the cumulative incidence of any non Q-wave myocardial infarction within the 24 hours following carotid stenting [ Time Frame: 1 year ] [ Designated as safety issue: Yes ]
peri-procedural (within 30 days of procedure) death, stroke, Q-wave myocardial infarction [ Time Frame: Within 30 days of Procedure ] [ Designated as safety issue: Yes ]
late ipsilateral stroke or death due to neurologic events from 31 days up to and including twelve-month follow-up. [ Time Frame: 1 year ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:

Peri-procedural morbidity and mortality [ Time Frame: Within 30 Days of procedure ] [ Designated as safety issue: Yes ]
FilterWire EX and EZ System technical success [ Time Frame: Post procedure ] [ Designated as safety issue: Yes ]
Carotid Wallstent technical success [ Time Frame: Post Procedure ] [ Designated as safety issue: Yes ]
system technical success [ Time Frame: Post Procedure ] [ Designated as safety issue: Yes ]
angiographic success [ Time Frame: Post Procedure ] [ Designated as safety issue: Yes ]
procedural success [ Time Frame: Post Procedure ] [ Designated as safety issue: Yes ]
30-day clinical success [ Time Frame: 30 days post procedure ] [ Designated as safety issue: Yes ]
peri-procedural overall morbidity [ Time Frame: 30 days post procedure ] [ Designated as safety issue: Yes ]
one-year clinical success [ Time Frame: 1 Year post procedure ] [ Designated as safety issue: Yes ]
late stroke, transient ischemic attack (TIA) and death. [ Time Frame: 1 year post procedure ] [ Designated as safety issue: Yes ]

Enrollment:	747
Study Start Date:	February 2002
Study Completion Date:	November 2007
Primary Completion Date:	May 2005 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Arm 1: Experimental	Device: WALLSTENT® Endoprosthesis™ Carotid Artery Stent

Detailed Description:

Stroke is the third leading cause of death in this country with approximately 600,000 new stroke cases each year. Mortality rates as high as 40 percent have been reported for stroke as a result of ischemia associated with the carotid distribution. Currently, the primary therapy for carotid artery occlusive disease is carotid endarterectomy (CEA) or the surgical removal of atheromatous material from inside the artery.

Although CEA is an effective treatment for the majority of patients with carotid occlusive disease, there remains a need for a treatment option for those patients with significant surgical risk factors. These patients have been shown to have much higher rates of morbidity and mortality. There are approximately 50,000-70,000 patients each year who are considered poor surgical candidates. These patients present with either one or more anatomical or co-morbid conditions and have a one-year stroke and death rate of up to 15% with traditional surgical treatment.

Carotid artery stenting (CAS) has been reported by numerous single-center trials to be feasible in the treatment of carotid artery stenosis. Moreover, the risk benefit ratio has been suggested to be the largest in those patients with a higher risk profile for the CEA treatment option.

This trial will study the effects of percutaneous intervention using the Monorail™ Carotid Wallstent® Endoprosthesis (Carotid Wallstent) in conjunction with the FilterWire System distal protection device (FilterWire EX and EZ) on rates of common peri-procedural complications as well as on long-term outcomes as compared to historical outcomes of patients undergoing CEA.

Eligibility

Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Key General Inclusion Criteria:

Patient must meet criteria for either A or B:

A. Symptomatic: Carotid stenosis of greater than or equal to 50% via angiography with associated cerebral or retinal TIA or ischemic stroke symptoms within 180 days of the procedure, which are determined to have occurred in the cerebral hemisphere or eye ipsilateral to the target carotid artery lesion and to be reasonably attributable to that lesion; or

B. Asymptomatic: Carotid stenosis greater than or equal to 80% via angiography without associated cerebral or retinal TIA or ischemic stroke symptoms within 180 days of the procedure.

Target lesion is in the native common carotid artery (CCA), internal carotid artery (ICA), or carotid bifurcation.
Target arterial segment to be stented has a diameter of greater than or equal to 4.0 mm to less than or equal to 9.0 mm.
Vessel diameter distal to the target lesion is greater than or equal to 3.5 mm and less than or equal to 5.5 mm as an optimal "landing zone" for placement of the FilterWire EZ System with visual angiographic recommendations as described in the instructions for use (IFU).

Key High-Risk Eligibility Inclusion Criteria:

Patients must qualify in at least one high-risk category. The high-risk categories are defined as:
- Anatomical conditions [one (1) criterion qualifies]
- Co-morbid conditions Class I [one (1) criterion qualifies]
- Co-morbid conditions Class II [two (2) criteria qualify]

Exclusion Criteria:

Patient has experienced an evolving, acute, or recent stroke within 21 days of study evaluation.
A total occlusion of the ipsilateral carotid artery. (Only for Roll-In and Pivotal patients.)
A total occlusion of the contralateral carotid artery. (Only for Bilateral Registry patients.)
Pre-existing stent(s):
- Roll-In and Pivotal Patients: located within the ipsilateral carotid distribution; a stent was placed in a contralateral vessel within the previous 30 days of the study enrollment.
- Bilateral Registry Patients: located within the carotid distribution.
A target lesion which is expected to require more than one stent.
Known cardiac sources of emboli of a type likely to be associated with cerebral ischemic events [e.g. endocarditis, intracardiac thrombus, embolic-associated cardiovascular lesions, or any current arrhythmia (e.g. atrial fibrillation, atrial flutter, etc.)].
Myocardial infarction (MI) within 72 hours prior to the index procedure, defined as creatine kinase (CK)-MB > 2 X the local laboratory's upper limit of normal (ULN).
Any surgery requiring general anesthesia (e.g. coronary artery bypass graft [CABG], valve replacement, or abdominal aortic aneurysm) less than or equal to 30 days preceding the stent procedure.
The patient is enrolled in another investigational study protocol and has not completed the required follow-up period of the evaluation. The patient may not participate in another investigational study that may confound the treatment or outcomes of the BEACH protocol.

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00316108

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Locations

United States, Alabama
University of Alabama at Birmingham
Birmingham, Alabama, United States, 35294
Bapatist Medical Center
Birmingham, Alabama, United States, 35211
United States, Arizona
Arizona Heart Institute
Phoenix, Arizona, United States, 85006
St. Joseph's Hospital & Medical Center
Phoenix, Arizona, United States, 85013
United States, California
El Camino Hospital
Mountain View, California, United States, 94040
Hoag Memorial Hospital
Newport Beach, California, United States, 92658
St. Joseph's Medical Center
Stockton, California, United States, 95204
United States, District of Columbia
Washington Hospital Center
Washington, District of Columbia, United States, 20010
United States, Florida
Miami Cardiac and Vascular Institute
Miami, Florida, United States, 33176
University of Miami School of Medicine - Jackson Memorial Hospital
Miami, Florida, United States, 33101
Northwest Medical Center
Plantation, Florida, United States, 33324
Holy Cross Hospital
Ft. Lauderdale, Florida, United States, 33308
Lakeland Regional Medical Center
Lakeland, Florida, United States, 33805
United States, Georgia
St. Joseph's Hospital of Atlanta/American Cardiovascular Research Institute
Atlanta, Georgia, United States, 30342
Piedmont Hospital
Atlanta, Georgia, United States, 30309
United States, Illinois
St. John's Hospital - Prairie Heart Institute
Springfield, Illinois, United States, 62701
St. Francis Medical Center
Peoria, Illinois, United States, 61637
Rush Presbyterian-St. Luke's Medical Center
Chicago, Illinois, United States, 60612
United States, Kentucky
Central Baptist Hospital
Lexington, Kentucky, United States, 40504
United States, Louisiana
Ochsner Clinic Foundation
New Orleans, Louisiana, United States, 70121
United States, Massachusetts
Cape Cod Hospital
Hyannis, Massachusetts, United States, 02601
Massachusetts General Hospital
Boston, Massachusetts, United States, 02114
United States, Michigan
Wayne State University- Detroit Medical Center
Detroit, Michigan, United States, 48034
William Beaumont Hospital
Royal Oak, Michigan, United States, 48073
United States, Missouri
St. Luke's Hospital of Kansas City
Kansas City, Missouri, United States, 64111
United States, New York
Lenox Hill Heart and Vascular Institute
New York, New York, United States, 10021
Kaleida Health/Millard Fillmore Hospital
Buffalo, New York, United States, 14209
Montefiore Medical Center
Bronx, New York, United States, 10467
St. Francis Hospital
Roslyn, New York, United States, 11576
New York Presbyterian Hospital/Columbia Vascular Interventional Radiology
New York, New York, United States, 10032
Strong Memorial Hospital
Rochester, New York, United States, 14603
United States, North Carolina
Duke University Medical Center
Durham, North Carolina, United States, 27710
United States, Ohio
Riverside Methodist Hospital
Columbus, Ohio, United States, 43202
Cleveland Clinic & Foundation
Cleveland, Ohio, United States, 44195
Medical College of Ohio
Toledo, Ohio, United States, 43614
United States, Oregon
Oregon Health Sciences University
Portland, Oregon, United States, 97201
United States, Pennsylvania
Hahnemann University/ Tenet Healthcare Corporation
Philadelphia, Pennsylvania, United States, 19102
UPMC-Shadyside Hospital Pittsburgh Vascular Institute
Pittsburgh, Pennsylvania, United States, 15232
Pinnacle Health at Harrisburg Hospital
Wormleysburg, Pennsylvania, United States, 17101
United States, South Carolina
Providence Hospital South Carolina Heart Center
Columbia, South Carolina, United States, 29204
United States, Tennessee
Skyline Medical Center/ Howell Allen Clinic
Nashville, Tennessee, United States, 37207
Baptist Hospital of East Tennessee
Knoxville, Tennessee, United States, 37920
United States, Texas
St. Luke's Episcopal Hospital Texas Heart Institute
Houston, Texas, United States, 77030
Baptist Hospital
San Antonio, Texas, United States, 78201
University of Texas-Houston Medical School
Houston, Texas, United States, 77030
Texas Tech University Health Sciences Center
Lubbock, Texas, United States, 79430
United States, Utah
LDS Hospital
Salt Lake City, Utah, United States, 84143
United States, Virginia
St. Mary's Hospital
Richmond, Virginia, United States, 23226
United States, Washington
Deaconess Medical Center
Spokane, Washington, United States, 99204
United States, Wisconsin
Aurora St. Luke's Medical Center
Milwaukee, Wisconsin, United States, 53215

Sponsors and Collaborators

Boston Scientific Corporation

Investigators

Principal Investigator:	Christopher White, MD	Ochsner Clinic Foundation
Principal Investigator:	Sriram Iyer, MD	Lenox Hill Heart and Vascular Institute
Study Director:	Pamela G Grady, Ph.D	Boston Scientific Corporation

More Information

Additional Information:

Click here for more information from Boston Scientific about Carotid Artery Disease (CAD) This link exits the ClinicalTrials.gov site

No publications provided by Boston Scientific Corporation

Additional publications automatically indexed to this study by National Clinical Trials Identifier (NCT ID):

Iyer SS, White CJ, Hopkins LN, Katzen BT, Safian R, Wholey MH, Gray WA, Ciocca R, Bachinsky WB, Ansel G, Joye JD, Russell ME; BEACH Investigators. Carotid artery revascularization in high-surgical-risk patients using the Carotid WALLSTENT and FilterWire EX/EZ: 1-year outcomes in the BEACH Pivotal Group. J Am Coll Cardiol. 2008 Jan 29;51(4):427-34.

Responsible Party:	Boston Scientific ( Christina Drager )
Study ID Numbers:	S5385, COR2000001U
Study First Received:	April 18, 2006
Last Updated:	August 28, 2008
ClinicalTrials.gov Identifier:	NCT00316108 History of Changes
Health Authority:	United States: Food and Drug Administration

Keywords provided by Boston Scientific Corporation:

Carotid
Carotid Artery Stenting
Stent
Carotid Endarterectomy

Stroke
Transient Ischemic Attack
Stenosis
Atherosclerotic Disease

Additional relevant MeSH terms:

Arterial Occlusive Diseases
Intracranial Arteriosclerosis
Nervous System Diseases
Stroke
Vascular Diseases
Central Nervous System Diseases

Cardiovascular Diseases
Arteriosclerosis
Brain Diseases
Carotid Artery Diseases
Intracranial Arterial Diseases
Cerebrovascular Disorders

ClinicalTrials.gov processed this record on November 27, 2009