OCT Evaluation of Healing of COMBO Stent (EGO-COMBO)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01274234
Recruitment Status : Completed
First Posted : January 11, 2011
Last Update Posted : February 28, 2013
Information provided by (Responsible Party):
Prof. Stephen Lee, The University of Hong Kong

Brief Summary:
All subjects requiring percutaneous coronary intervention (PCI) and stenting are eligible to participate in the study. Restudy coronary angiogram with Optical Coherence Tomography (OCT) would be performed between 1 to 5 months at the time of a staged PCI procedure (for remaining coronary disease) or as clinically indicated, and then at 9 months. At the time of the 9-month restudy (a proper time window for drug eluting stent to develop into restenosis should it occur), any new disease detected or restenosis will be treated. The reported incidence of drug eluting stent restenosis is around 10% in simple lesions and is expected to be higher in diabetic patients, long lesions and multi-vessel diseases; a restudy at 9 months actually confers better protection to the patients with advanced disease and any restenosis can be treated timely. All data on clinical events and progress will be monitored and regular follow-ups will be carried out.

Condition or disease Intervention/treatment Phase
Coronary Restenosis Coronary Thrombosis Device: COMBO Stent (OrbusNeich Medical, Fort Lauderdale, Florida) Phase 1 Phase 2

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Detailed Description:

The GENOUS Stent (the EPC Capturing R-stent, OrbusNeich Medical Inc., Fort Lauderdale, FL) is commercially available and has been extensively used in standard coronary intervention procedures treating >200 patients with critical coronary stenoses at Queen Mary Hospital. The COMBO Stent (OrbusNeich Medical Inc., Fort Lauderdale, FL) is a hybrid version of the GENOUS Stent with an abluminal sirolimus coating, and is currently under the investigational use for clinical research in the REMEDEE Study; over 20 patients have been treated and all remained in good condition since the treatment.

The GENOUS Stent is a bio-engineered 316L stainless steel coronary stent with a biocompatible circumferential coating of anti-CD34 antibody, and will bind to and therefore capture the circulatory endothelial progenitor cells (EPC) which have CD34 antigen on the surface. Immobilization of EPCs on the stent surface will encourage differentiation and proliferation of the EPCs into endothelial and neointimal layer. Animal model has demonstrated that a functional endothelial layer could be formed as soon as 24 to 48 hours after GENOUS stent implantation (1). The HEALING-FIM registry has shown that GENOUS stent is clinically safe and effective in the treatment of coronary stenosis (2). Recent reports have further confirmed its efficacy in patients with acute coronary syndrome requiring urgent revascularization (3,4).

The COMBO Stent is a hybrid version of the GENOUS Stent, with an additional abluminal, drug eluting sirolimus coating, targeted to reduce excessive neointima formation, while maintaining the EPC capturing capacity and therefore continue to promote healing after stent injury. The hybrid function of these two technologies in this new COMBO stent is expected to produce better clinical results in terms of accelerated healing, less stent thrombosis and less restenosis; these are being investigated in the current REMEDEE Study.

Animal study has shown the COMBO Stent promotes endothelialization and reduces neointima formation, as assessed by both optical coherence tomography (OCT) and histopathology (5). Even though COMBO Stents have been used and found to be safe in over 180 patients world-wide and in about 30 patients at Queen Mary Hospital under the REMEDEE Study Protocol, such benefits of "early" endothelial coverage as assessed by OCT has never been fully documented in human subjects.

The current EGO-COMBO study protocol is designed based on the approved protocols of the ongoing REMEDEE Study (IRB: UW 09-384) and the EGO Study (IRB: UW 10-256); both are still active in this Hospital. In the multi-center REMEDEE Study, the COMBO stent is compared to the TAXUS stent (Boston Scientific) in patients with coronary artery disease requiring stent implantation, looking at the 9 months late loss results. This EGO-COMBO Study is different from the REMEDEE Study and focuses mainly on the very early time frames assessing the degree of early neointimal healing (enhanced endothelialization) between 2nd to 5th months, and the subsequent neointimal proliferation at 9 months after the COMBO Stent implantation, as assessed by the very high resolution of the frequency domain optical coherence tomography (OCT) used in the existing EGO study. This is a single centre, non-randomized, open-label study.

Intracoronary frequency domain optical coherence tomography (FD-OCT) is a simple catheter-based imaging technique using optic fibre to achieve very detailed assessment (resolution down to 10 microns) of the stents, in terms of stent apposition, early neointimal coverage (enhanced endothelialization) and late stent neointimal growth (restenosis). It is performed as part of the routine cardiac catheterization procedure and provides high-resolution cross sectional images of the coronary arteries. OCT has been shown to be safe in clinical practice (6, 7). The LightLab C7XR OCT System (Frequency Domain OCT) is a commercially available product with CE Mark and FDA approval, and is being used in our EGO Study. The Dragonfly OCT catheter used is a non-occlusive optic fibre which is extremely small and flexible, and will pose absolutely no additional risk to the patient under treatment, other than those inherent risks of a standard angioplasty procedure.

In this prospective, pilot study, OCT is used to image the COMBO Stent after implantation to evaluate both the early healing (stent apposition, neointimal coverage) and late lumen loss (neo-intimal thickness and neo-intimal area). Clinical outcomes will also be monitored as secondary end points. The OCT analyses will be performed by an USA based core laboratory, which is blinded from the time frame of the OCT pullbacks and the clinical details.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 61 participants
Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: Single (Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Evaluation of Neointimal Healing of Endothelial Progenitor Cell Capturing Sirolimus-Eluting (COMBO) Stent by Optical Coherence Tomography: the EGO-COMBO Pilot Study
Study Start Date : October 2010
Actual Primary Completion Date : June 2012
Actual Study Completion Date : June 2012

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Blood Clots
Drug Information available for: Sirolimus

Arm Intervention/treatment
Experimental: COMBO Stent
Device: COMBO Stent (OrbusNeich Medical, Fort Lauderdale, Florida)
The COMBO Stent is a hybrid version of the GENOUS Stent. Upon implantation to the coronary artery, the stent will deliver a drug (sirolimus) to the wall of the treated segment to suppress neointimal growth, in addition to the anti-CD34 antibody coating which will in theory attract circulatory endothelial progenitor cells to hasten endothelialization and promote healing of the stented segment, and thereby may reduce late stent thrombosis.
Other Name: COMBO Stent

Primary Outcome Measures :
  1. Primary end-point: OCT findings on percentage stent strut coverage in the 2nd to the 5th months (4 monthly groups). [ Time Frame: On 2nd, 3rd, 4th, and 5th months ]
    Primary end-point: OCT findings on percentage stent strut coverage, malapposition, and neointimal thickness in the 2nd to the 5th months (4 monthly groups).

Secondary Outcome Measures :
  1. OCT findings on late loss (neointimal thickness and neointimal area) at 9 months restudy. [ Time Frame: 9 months ]
    OCT findings on late loss (neointimal thickness, neointimal area, percentage plaque volume, lumen area, and late loss in lumen area) at 9 months restudy.

  2. Major Adverse Cardiac Events [ Time Frame: Initial OCT follow up, 9 months follow up and one year follow up ]

    Major Adverse Cardiac Events (MACE) which defined as:

    1. Death from all cause including cardiac death
    2. Any Myocardial Infarction (Q wave and non Q-wave)

    Elevation of post-procedure CK levels to greater 2 times normal without new Q waves is considered a non Q-wave MI.

    Development of new, pathological Q waves in 2 or more contiguous leads,as assessed by the investigator and confirmed by the Clinical Endpoint Committee and elevation of cardiac enzymes. In the absence of ECG data the CEC may adjudicate Q wave MI based on the clinical scenario and appropriate cardiac enzyme data.

  3. Major Adverse Cardiac Events [ Time Frame: Initial OCT follow up, 9 months OCT follow up and one year follow up ]
    3. Target Lesion Revascularization requiring repeat PCI or CABG to the target lesion. Clinically driven Revascularization at the target lesion associated with positive functional ischemia study or ischemic symptoms AND an angiographic minimal lumen diameter stenosis ≥50% by QCA, or revascularization of a target lesion with diameter stenosis ≥ 70% by QCA without either angina or a positive functional study.

  4. Any Stent Thrombosis according the Academic Research Consortium [ Time Frame: Initial OCT follow up, 9 months OCT follow up and one year follow up ]
  5. Stroke [ Time Frame: Initial OCT follow up, 9 months OCT follow up and one year follow up ]
    Stroke defined as sudden onset of vertigo, numbness, dysphasia, weakness, visual field defects, dysarthria or other focal neurological deficits due to vascular lesions of the brain such as hemorrhage, embolism, thrombosis, or rupturing aneurysm, that persists more than 24 hours.

  6. Bleeding complication [ Time Frame: Initial OCT follow up, 9 months OCT follow up and one year follow up ]
    Bleeding complication defined as a procedure related hemorrhagic event that requires a transfusion or surgical repair. These may include a hematoma requiring treatment of retroperitoneal bleed.

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Ages Eligible for Study:   18 Years to 85 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • patient aged 18-85 years old,
  • patient with coronary stenosis requiring percutaneous coronary intervention without contraindications to implantation of drug eluting stents
  • patient who consents to receive follow-up coronary angiogram and OCT examination.

Exclusion Criteria:

- patient who refuses to consent to follow-up coronary angiogram or OCT examination.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01274234

Hong Kong
Division of Cardiology, Queen Mary Hospital, The University of Hong Kong
Hong Kong, Hong Kong
Sponsors and Collaborators
Prof. Stephen Lee
Principal Investigator: Stephen Lee, MD FRCP FACC Queen Mary Hospital, The Unversity of Hong Kong

Publications of Results:

Publications automatically indexed to this study by Identifier (NCT Number):
Responsible Party: Prof. Stephen Lee, Professor and Chief, The University of Hong Kong Identifier: NCT01274234     History of Changes
Other Study ID Numbers: UW 10-342 (IRB HKU)
First Posted: January 11, 2011    Key Record Dates
Last Update Posted: February 28, 2013
Last Verified: February 2013

Keywords provided by Prof. Stephen Lee, The University of Hong Kong:
EPC capturing sirolimus eluting COMBO stent
Optical coherence tomography (OCT)
Early neointimal healing and stent coverage
Late neointimal thickness, neointimal area, and lumen loss

Additional relevant MeSH terms:
Coronary Restenosis
Coronary Thrombosis
Embolism and Thrombosis
Vascular Diseases
Cardiovascular Diseases
Coronary Stenosis
Coronary Disease
Myocardial Ischemia
Heart Diseases
Anti-Bacterial Agents
Anti-Infective Agents
Antibiotics, Antineoplastic
Antineoplastic Agents
Antifungal Agents
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs