Pulmonary Embolism and ThrombosisPhase 4OPTALYSE PENCT02396758
Optimum Duration of Acoustic Pulse Thrombolysis Procedure in Acute Pulmonary Embolism
A Phase 4 study testing Ekosonic® Endovascular Device ultrasonic infusion catheter and Recombinant tissue plasminogen activator in people with Pulmonary Embolism and Thrombosis, run by Boston Scientific Corporation at 21 sites in 2 countries.
Trial summary
The objective is to determine the optimum dose of thrombolytic and duration of the ultrasound procedure (together defined as the APT Procedure) as a treatment for acute submassive pulmonary embolism (PE). Read more about this study
- Who is it for?
- Ages 18 to 75 years
- Conditions the study is for
- Pulmonary Embolism and Thrombosis
- What is being tested?
- Ekosonic® Endovascular Device ultrasonic infusion catheter and Recombinant tissue plasminogen activator
- Type of treatment
- Injection or infusion, Medical device
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 131 participants
- Where
- 21 sitesin 2 countries
- Study dates
- 12 Jun 2015to 30 Jan 2020
- Phase
- Phase 4
- Are there results?
- Yes, posted in the registrySummary in the doctors' view
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 75 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Male or female greater than or equal to (≥) 18 years of age and less than or equal to (≤) 75 years of age.
- CTA evidence of proximal PE (filling defect in at least one main or lobar pulmonary artery).
- PE symptom duration ≤14 days.
- Submassive PE: RV/LV diameter ≥ 0.9 from CTA and hemodynamically stable. For Participants in UK Sites: Submassive PE: RV/LV diameter ≥ 0.9 from CTA, hemodynamically stable and an elevated biomarker.
- Must be treated within 48 hours of diagnosis of PE by CTA.
- Signed Informed consent obtained from subject or Legally Authorized Representative.
Who cannot join
- Stroke or transient ischemic attack (TIA), head trauma, or other active intracranial or intraspinal disease within one year.
- Recent (within one month) or active bleeding from a major organ.
- Major surgery within seven days of screening for study enrollment.
- Clinician deems the subject high-risk for catastrophic bleeding.
- History of heparin-induced thrombocytopenia (HIT).
- Catheter-based pharmacomechanical treatment for PE within 3 days of study enrollment.
Show all 17Show fewer
- Systolic blood pressure (SBP) less than 90 mm Hg and/or use of vasopressors.
- Cardiac arrest (including pulseless electrical activity and asystole) requiring active cardiopulmonary resuscitation (CPR).
- Evidence of irreversible neurological compromise.
- Life expectancy < one year. For Participants in UK Sites: Life expectancy < one year or enrollment in hospice care.
- Use of thrombolytics or glycoprotein IIb/IIIa antagonists within 3 days prior to inclusion in the study.
- Out-of-Range Laboratory Values: Hematocrit < 30%, Platelets < 100 thousand/microliter (μL), International normalized ratio (INR) > 3.
- Creatinine outside the normal range for the treating institution.
- Participant is pregnant (positive pregnancy test; women of childbearing capacity must be tested) or breast feeding.
- Active cancer (metastatic, progressive, or treated within the last 6 months). Exception: participants with non-melanoma primary skin cancers are eligible to participate in the study.
- Known allergy, hypersensitivity, or thrombocytopenia from heparin, r-tPA, or iodinated contrast except for mild-moderate contrast allergies for which steroid pre-medication can be used.
- History of any hematologic disease potentially involving abnormal platelet number or function.
Trial locations and contacts
21 sites in 2 countries.
21 sites in 2 countries
United States16 sites
Inova Alexandria Hospital
Alexandria, Virginia
Piedmont Hospital
Atlanta, Georgia, 30309
University Hospital
Augusta, Georgia, 30901
Cedars Sinai
Beverly Hills, California, 90211
Mount Carmel Health System
Columbus, Ohio, 43213
Detroit Medical Center
Detroit, Michigan, 48201
UPMC Hamot
Erie, Pennsylvania, 16507
St. Vincent Medical Group
Indianapolis, Indiana, 46260
Jewish Hospital
Louisville, Kentucky, 40202
East Jefferson General Hospital
Metairie, Louisiana, 70006
Vanderbilt University Medical Center
Nashville, Tennessee, 37232
Houston Methodist Sugarland Hospital
Richmond, Texas, 77469
Providence Sacred Heart Medical Center
Spokane, Washington, 99204
Tallahassee Memorial Hospital
Tallahassee, Florida, 32308
Florida Hospital Tampa
Tampa, Florida, 33613
Lankenau Medical Center
Wynnewood, Pennsylvania, 19096
United Kingdom5 sites
Ninewells Hospital
Dundee, Scotland, DD1 9SY
Royal Devon & Exeter Hospital
Exeter, England, EX2 5DW
Medway Maritime Hospital
Gillingham, England, ME7 5NY
Royal Free Hospital
London, England, NW3 2QG
St. Thomas Hospital
London, England, SE1 7EH
About this study
Official title: Study of the OPTtimum Duration of Acoustic Pulse ThromboLYSis ProcEdure in the Treatment of Acute Submassive Pulmonary Embolism
The objective is to determine the optimum dose of thrombolytic and duration of the ultrasound procedure (together defined as the APT Procedure) as a treatment for acute submassive pulmonary embolism (PE). Symptomatic submassive PE are participants with acute (less than or equal to [≤]14 days) PE with normal systemic arterial blood pressure (greater than [>] 90 mmHg) and evidence of RV dysfunction (right ventricular to left ventricular diameter ratio, that is; RV/LV ratio greater than or equal to [≥] 0.9). Participants with submassive PE will be randomized to one of four APT treatment groups: ultrasound of 2 and 6 hours (hrs) with r-tPA 2 milligrams (mg)/hr/catheter and ultrasound 4 and 6 hours with r-tPA, 1 mg/hr/catheter. On 08 June 2016, randomization into treatment group 4 (APT/6 hours-r-tPA/2 mg/hr/catheter) was closed following a reported intracranial hemorrhage (ICH) and death in a study participant in this arm.
Read the detailed description
This study is designed to investigate the lowest recombinant tissue plasminogen activator (r-tPA) dose-ultrasound treatment time required to achieve the same reductions in thrombus burden and associated improvement in physiologic parameters demonstrated in ULTIMA (EKOS 08 [NCT01166997]) and SEATTLE II (EKOS 09 [NCT01513759]). Results of this study are intended to inform the study design for further studies of the Acoustic Pulse Thrombolysis (APT) Procedure. Analysis of the first 100 evaluable participants in the United States study suggested a degree of equipoise between treatment groups 1, 2 and 3 of the protocol and therefore the sample size has been extended and additional sites in the United Kingdom (UK) National Health Service included, with a view to adding to the findings of the OPTALYSE study from sites in the UK and increasing the number of participants treated by treatment protocol.
- Conditions
- Pulmonary Embolism and Thrombosis
- Being tested
- Ekosonic® Endovascular Device ultrasonic infusion catheter, Recombinant tissue plasminogen activator
- Medical subject headings
- Pulmonary Embolism, Thrombosis
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Ekosonic® Endovascular Device ultrasonic infusion catheterDevice
Also called Acoustic Pulse Thrombolysis Procedure (APT Procedure), EKOS
r-tPA will be administered via EKOS.
Recombinant tissue plasminogen activatorBiological
Also called r-tPA
Recombinant tissue plasminogen activator will be administered as per the dose and schedule specified in the arm.
| Study group | Role | What they receive |
|---|---|---|
| APT/2 Hours-r-tPA/2 mg/hr/Catheter | Experimental | A total of 4 or 8 mg r-tPA (as 2 mg/hour [hr]/catheter) will be delivered through Ekosonic® Endovascular Device (EKOS) ultrasonic infusion catheter for 2 hrs. Receives: Device: Ekosonic® Endovascular Device ultrasonic infusion catheter; Biological: Recombinant tissue plasminogen activator |
| APT/4 Hours-r-tPA/1 mg/hr/Catheter | Experimental | A total of 4 or 8 mg r-tPA (as 1 mg/hr/catheter) will be delivered through EKOS ultrasonic infusion catheter for 4 hrs. Receives: Device: Ekosonic® Endovascular Device ultrasonic infusion catheter; Biological: Recombinant tissue plasminogen activator |
| APT/6 Hours-r-tPA/1 mg/hr/Catheter | Experimental | A total of 6 or 12 mg r-tPA (as 1 mg/hr/catheter) will be delivered through EKOS ultrasonic infusion catheter for 6 hrs. Receives: Device: Ekosonic® Endovascular Device ultrasonic infusion catheter; Biological: Recombinant tissue plasminogen activator |
| APT/6 Hours-r-tPA/2 mg/hr/Catheter | Experimental | A total of 12 or 24 mg r-tPA (as 2 mg/hr/catheter) will be delivered through EKOS ultrasonic infusion catheter for 6 hrs. Receives: Device: Ekosonic® Endovascular Device ultrasonic infusion catheter; Biological: Recombinant tissue plasminogen activator |
What is being measured
The primary outcome is the main question the study is designed to answer.
Change From Baseline in the Right Ventricle (RV) Diameter-to-Left Ventricle (LV) Diameter Ratio to 48 ± 6 Hours After the Start of the APT Procedure
Change from baseline in RV/LV will be determined by computed tomographic angiography (CTA).
Measured: Change from Baseline to 48 hrs ± 6 hours
Number of Participants With Major Bleeding Within 72 Hours After Initiating the APT Procedure
Criteria for major bleeding events, as defined by the International Society on Thrombosis and Haemostasis (ISTH): 1. Fatal bleeding and/or; 2. Symptomatic bleeding in a critical area or organ (intracranial, intraspinal, intraocular, retroperitoneal, intra-articular or pericardial, or intramuscular with compartment syndrome) and/or; 3. Bleeding causing a fall in hemoglobin level of 20 grams/liter (g/L) or more, or leading to transfusion of two or more units of whole blood or red blood cells.
Measured: Day 3 (within 72 hours after initiating the APT procedure)
Secondary outcomes (25)
Percentage of Participants With Treatment Success of an APT Procedure
Treatment success of an APT procedure will be assessed by an Adjudication Committee that is blinded to the participant's treatment. The criteria for treatment success are defined as follows: A decrease in RV/LV from baseline to 48 hours after the start of the procedure of at least 0.2; and no life-threatening adverse events related to PE or its treatment through 30 days after the start of the APT procedure.
Measured: From Baseline up to Day 30
Change From Baseline in RV/LV at Days 0, 2, 30, 90, and 365, as Assessed by Echocardiograph.
An echocardiogram was obtained at specified timepoints to evaluate RV/LV.
Measured: Baseline (Day -2 [within -48 hrs of APT start]), Day 0 (within 4 hours after APT end), Day 2 (48 [± 6] hrs of APT start), Day 30 (± 5 days), Day 90 (± 10 days) and Day 365 (± 14 days)
Change From Baseline in Tricuspid Annular Plane Systolic Excursion (TAPSE) at Days 0, 2, 30, 90, and 365, as Assessed by Echocardiograph
The extent of displacement of the tricuspid valves, termed as TAPSE was measured at specified timepoints using echocardiogram.
Measured: Baseline (Day -2 [within -48 hrs of APT start]), Day 0 (within 4 hours after APT end), Day 2 (48 [± 6] hrs of APT start), Day 30 (± 5 days), Day 90 (± 10 days) and Day 365 (± 14 days)
Change From Baseline in Estimated Right Ventricular Systolic Pressure (RVSP) at Days 0, 2, 30, 90, and 365, as Assessed by Echocardiograph
RVSP was measured at specified timepoints using echocardiogram.
Measured: Baseline (Day -2 [within -48 hrs of APT start]), Day 0 (within 4 hours after APT end), Day 2 (48 [± 6] hrs of APT start), Day 30 (± 5 days), Day 90 (± 10 days) and Day 365 (± 14 days)
Percentage of Participants With Collapse of the Inferior Vena Cava (IVC) With Respiration at Days 0, 2, 30, 90, and 365, as Assessed by Echocardiograph
The collapse of IVC was measured at specified timepoints using echocardiogram.
Measured: Baseline (Day -2 [within -48 hrs of APT start]), Day 0 (within 4 hours after APT end), Day 2 (48 [± 6] hrs of APT start), Day 30 (± 5 days), Day 90 (± 10 days) and Day 365 (± 14 days)
Change From Baseline in Thrombus Burden by Miller Score as Assessed by Pulmonary Arteriogram (PAgram) at Day 0
Miller score is composed of a score for arterial obstruction (objective score) and a score for reduction of peripheral perfusion of lungs (subjective evaluation). Right pulmonary artery (PA) is assigned 9 segmental arteries (3 to the upper, 2 to the middle, and 4 to the lower lobe), and left PA is assigned only 7 segmental arteries (2 to the upper, 2 to the lingula, and 3 to the lower lobe). Presence of segmental emboli, regardless of the degree of obstruction, is scored 1 point. Proximal emboli to the segmental level are scored a value equal to the number of segmental arteries arising distally. Maximal score of obstruction=16. Reduction of peripheral perfusion is scored by dividing each lung into upper, middle, and lower zones and by using a 4-point scale: 0=normal perfusion; 1=moderately reduced perfusion; 2=severely reduced perfusion; 3=no perfusion. Maximal score of reduced perfusion=18. Thus, the maximal Miller score =34. Higher Miller score=more thrombus burden.
Measured: Baseline, Day 0 (within 4 hours after APT end)
Change From Baseline in Thrombus Burden by Modified Miller Score as Assessed by CTA Scan at 48 ± 6 Hours After the Start of the APT Procedure
Modified miller score quantifies thrombus burden on CTA scans. Each segmental pulmonary artery (9 on the right, 7 on the left) that is fully or partly occluded by thrombus is given a score of 1. Any further proximal involves vessels score the number of segmental branches distal to that vessel, thereby giving a modified miller score of 0 (no thrombus) to 16 (thrombus in all segmental arteries or saddle embolism).
Measured: From Baseline to 48 hrs ± 6 hours
Change in 6 Minute Walk (6MW) Distance From Day 30 to Day 90 and 365
The 6 minute Walk Test is a measure of functional exercise capacity. Participants will be asked to walk as far as possible within a 6-minute period, and the distance covered at the end will be noted and recorded.
Measured: Days 30, 90, 365
Change in Borg Scale Score Before and After 6MW Distance Test at Days 30, 90, and 365
Borg is a 10-point scale rating the maximum level of dyspnea (difficulty in breathing) and fatigue experienced before and after the 6MW distance test. Scores ranges from 0 (for no shortness of breath, or no fatigue) to 10 (for the greatest shortness of breath ever experienced, or maximum amount of fatigue felt). Higher scores indicates worse outcome.
Measured: Days 30, 90, and 365
Number of Participants Who Received Oxygen Therapy
Oxygen source is categorized as room air, nasal prongs, mask, and intubated.
Measured: Days 30, 90, and 365
Change in Participant Reported Outcomes Measurement Information System Physical Function (PROMIS-PF) 6b Score From Day 30 to Day 365
PROMIS-PF 6b questionnaire is developed by including 2-items from item-improved Health Assessment Questionnaire (HAQ) and 4-items from item-improved Physical Function-10 (PF-10) instruments. Both of these instruments assess participant's present abilities. Both "Item-Improved instruments" have 5-response options: HAQ - 1="without any difficulty," 2="with a little difficulty," 3="with some difficulty," 4="with much difficulty," 5="unable to do"; PF-10 - 1="not at all," 2="very little," 3="somewhat," 4="quite a lot," 5="cannot do." Total score is the average of all scores of component items, which ranges from 0 (no disability) to 100 (worst disability).
Measured: Day 30, Day 365
Change in Pulmonary Embolism Quality of Life (PEmb-QOL) Score From Day 30 to Day 365
The PEmb-QoL questionnaire contains 6 dimensions that has been created based on the contents of the items, frequency of complaints (Question [Q]1; score range: 1 [every day] to 5 [never]), activities of daily living (ADL) limitations (Q4; score range: 1 [limited a lot] to 3 [not at all]), work-related problems (Q5; response: yes/no), social limitations (Q6; score range: 1 [not at all] to 5 [extremely]), intensity of complaints (Q7 [pain in chest/shoulders]/8 [breathlessness]; score range: 1 [none] to 6 [very serious]) and emotional complaints (Q9; score range: 1 [at all times] to 6 [none of the times]). Total Score for all dimensions are calculated by the sum of the scores for each item of the dimension divided by the number of items. Total score ranges from 1 (better quality of life) to 100 (worst quality of life). Higher scores indicate poorer outcome (decreased quality of life). Questions 1, 4, 5, and 9 are reverse scored. Questions 2 and 3 provide descriptive information.
Measured: Day 30, Day 365
Number of Participants Who Encountered Technical Procedural Complications
Technical complications associated with the use of the EKOS device will be recorded during catheter placement in the pulmonary artery and during the infusion procedure.
Measured: From device placement through Day 2
Number of Participants With Symptomatic Recurrent Pulmonary Embolism (Per Adjudication)
Number of participants with symptomatic recurrent pulmonary embolism up to 365 days following the APT procedure, were reported. A summary of serious and all other non-serious adverse events regardless of causality is located in the Reported Adverse Events module.
Measured: From Baseline up to Day 365
Number of Participants Who Die Due to Any Cause
Number of participants who died due to any cause for up to 365 days following the APT procedure, were reported.
Measured: From Baseline up to Day 365
For Participants of UK Sites: Freedom From Major Harm Occurring Between Enrolment and 30 Days
Number of UK participants with freedom from major harms assessed by Safety Monitor using the following criteria: 1) Mortality - all cause and PE related; 2) Cardiovascular (CV) collapse defined as one or more of the following: a) Greater than (>) 40 millimeters of mercury (mmHg) drop in systolic blood pressure (SBP) (for >15 minutes from documented blood pressure as an in-patient) despite intravenous (IV) fluid challenge and absence of new atrial arrhythmia; b) Requirement for emergency systemic thrombolysis; c) Requirement for emergency surgical embolectomy ; d) Requirement for vasopressors; e)and/or Intubation/Ventilation; 3) Major bleeding per ISTH; 4) Recurrent PE (confirmed by imaging); and/or 5) Surgical correction of device related complication. Due to changes in the protocol, there were no subjects enrolled in the UK in Treatment Arm 4.
Measured: From Baseline up to Day 30
For Participants of UK Sites:Change in EuroQual - 5 Dimensions - 5 Levels (EQ-5D-5L) Score From Day 30 to Day 365
The EQ-5D-5L consists of 2 parts - the descriptive system (Index Score) and the EQ Visual Analogue scale (VAS Score). The EQ-5D-5L descriptive system comprises 5 dimensions (mobility, self care, usual activities, pain/discomfort, anxiety/depression) and each dimension has 5 levels: no problems (1), slight problems (2), moderate problems (3), severe problems (4), and extreme problems (5). Each one digit number expressing the level selected for each dimension is combined into a 5-digit number describing the respondent's heath state. These 5-digit numbers are converted into an index value, where 1 represents full health and 0 is equivalent to death. The EQ VAS records the respondent's self-rated health on a vertical, visual analogue scale with 100 being the best health imaginable and 0 being the worst health imaginable. Due to changes in the protocol, there were no subjects enrolled in the UK in Treatment Arm 4.
Measured: Day 30, Day 365
For Participants of UK Sites: Time From Hospital Admission to Diagnosis of PE
Duration of time between hospital admission and the diagnosis of pulmonary embolism (PE) measured in hours for UK participants.Due to changes in the protocol, there were no subjects enrolled in the UK in Treatment Arm 4.
Measured: From Baseline through Day 3
For Participants of UK Sites: Time From Diagnostic Computed Tomography (CT) Scan to Initiation of Treatment for PE
Duration of time between Diagnostic Computed Tomography (CT) Scan to Initiation of Treatment for pulmonary embolism (PE) measured in hours for UK Participants. Due to changes in the protocol, there were no subjects enrolled in the UK in Treatment Arm 4.
Measured: From Baseline through Day 3
For Participants of UK Sites: Time in Each Level of Care (Level 0 and 1; Level 2; and/or Level 3) Through Discharge
Levels are defined according to National Framework Document: Level 0 - normal acute ward care (patients whose needs can be met through normal ward care in an acute hospital), Level 1 - acute ward care, with additional advice and support from the critical care team (Patients at risk of their condition deteriorating, or those recently relocated from higher levels of care, whose needs can be met on an acute ward with additional advice from a critical care team), Level 2 - more detailed observation or intervention (requiring more detailed observation or intervention including support for a single failing organ system or post-operative care and those 'stepping down' from higher levels of care) and Level 3 - advanced respiratory support alone, or basic respiratory support together with support of at least two organ systems (includes all complex patients requiring support for multi-organ failure). Due to changes in the protocol, there were no subjects enrolled in the UK in Treatment Arm 4.
Measured: From Baseline up to Hospital Discharge
Healthcare Resource Utilization: Team Managing the Participant During Hospitalization - Number of Healthcare Professional (HCP) Specialties Involved. (UK Participants Only)
Number of Healthcare Professional (HCP) Specialists involved with care of participant during hospitalization of UK participants.Due to changes in the protocol, there were no subjects enrolled in the UK in Treatment Arm 4.
Measured: From Baseline up to Day 365
Healthcare Resource Utilization: Number of Healthcare Professionals (HCP) Visits for Venous Thromboembolism (VTE) After Hospitalization and During 12month Follow-up. (UK Participants Only)
Number of Healthcare Professional (HCP) Specialists involved with care of participant for Venous Thromboembolism (VTE) after hospitalization through 365 days for UK participants. Due to changes in the protocol, there were no subjects enrolled in the UK in Treatment Arm 4.
Measured: From Day 30 up to Day 365
Healthcare Resource Utilization: Number of Healthcare Professionals (HCP) Visits for Venous Thromboembolism (VTE) After Hospitalization and During 12 Month Follow-up. (UK Participants Only)
Number of Healthcare Professional (HCP) Specialists involved with care of participant for Venous Thromboembolism (VTE) after hospitalization through 365 days for UK participants. Due to changes in the protocol, there were no subjects enrolled in the UK in Treatment Arm 4.
Measured: From Day 30 up to Day 365
Healthcare Resource Utilization: Number of Hospital Re-Admissions After Hospitalization and During 12 Month Follow-up. (UK Participants Only)
Number of Hospital Re-Admissions after hospitalization and during 12 month follow-up for UK Participants. Due to changes in the protocol, there were no subjects enrolled in the UK in Treatment Arm 4.
Measured: From Day 30 up to Day 365
Healthcare Resource Utilization: Duration of Hospital Re-Admissions After Hospitalization and During 12 Month Follow-up. (UK Participants Only)
Duration of Hospital Re-Admissions after hospitalization and during 12 month follow-up for UK Participants. Due to changes in the protocol, there were no subjects enrolled in the UK in Treatment Arm 4.
Measured: From Day 30 through Day 365
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted24 Mar 2015 (estimated)
- Study start12 Jun 2015
- Primary completion30 Apr 2019
- Study completion30 Jan 2020
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Posted resultsParticipant flow, outcome measures and adverse events reported by the sponsor.
- Publications (2)Papers the sponsor has linked to this study.
- Other trials for Pulmonary Embolism and ThrombosisStudies of the same condition, open and under way.
- More trials run by Boston Scientific CorporationThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 4
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 131 participants (actual)
Sponsor and investigators
- Lead sponsor
- Boston Scientific Corporation
- Sponsor type
- Industry (pharma, biotech, devices)
- Collaborators
- EKOS Corporation
- Responsible party
- Sponsor
- Investigators
- Victor Tapson, MD, Principal investigator, Cedar Sinai, Los Angeles
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT02396758
- Sponsor's protocol ID
- EKOS-12
- Other IDs
- 2016-000502-11, 2016
- Acronym
- OPTALYSE PE
- Status last verified
- Jul 2021
- First submitted
- 10 Mar 2015
- Last updated
- 19 Jul 2021
- Results posted
- Yes, on ClinicalTrials.gov
- Data monitoring committee
- No
Publications
Piazza G, Sterling KM, Tapson VF, Ouriel K, Sharp ASP, Liu PY, Goldhaber SZ. One-Year Echocardiographic, Functional, and Quality of Life Outcomes After Ultrasound-Facilitated Catheter-Based Fibrinolysis for Pulmonary Embolism. Circ Cardiovasc Interv. 2020 Aug;13(8):e009012. doi: 10.1161/CIRCINTERVENTIONS.120.009012. Epub 2020 Aug 6.
PubMed 32757658Tapson VF, Sterling K, Jones N, Elder M, Tripathy U, Brower J, Maholic RL, Ross CB, Natarajan K, Fong P, Greenspon L, Tamaddon H, Piracha AR, Engelhardt T, Katopodis J, Marques V, Sharp ASP, Piazza G, Goldhaber SZ. A Randomized Trial of the Optimum Duration of Acoustic Pulse Thrombolysis Procedure in Acute Intermediate-Risk Pulmonary Embolism: The OPTALYSE PE Trial. JACC Cardiovasc Interv. 2018 Jul 23;11(14):1401-1410. doi: 10.1016/j.jcin.2018.04.008.
PubMed 30025734
Study at a glance
From the registry record, last updated by the sponsor on 19 Jul 2021. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Study of the OPTtimum Duration of Acoustic Pulse ThromboLYSis ProcEdure in the Treatment of Acute Submassive Pulmonary Embolism
- ClinicalTrials.gov ID
- NCT02396758
- Acronym / sponsor ID
- OPTALYSE PE / EKOS-12
- Conditions
- Pulmonary Embolism and Thrombosis
- Phase
- Phase 4
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 131 participants (actual)
- Lead sponsor
- Boston Scientific CorporationIndustry (pharma, biotech, devices)
- Collaborators
- EKOS Corporation
- Study start
- 12 Jun 2015 (actual)
- Primary completion
- 30 Apr 2019 (actual)
- Study completion
- 30 Jan 2020 (actual)
- First posted
- 24 Mar 2015 (estimated)
- Results
- Posted 2 Mar 2021
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The objective is to determine the optimum dose of thrombolytic and duration of the ultrasound procedure (together defined as the APT Procedure) as a treatment for acute submassive pulmonary embolism (PE). Symptomatic submassive PE are participants with acute (less than or equal to [≤]14 days) PE with normal systemic arterial blood pressure (greater than [>] 90 mmHg) and evidence of RV dysfunction (right ventricular to left ventricular diameter ratio, that is; RV/LV ratio greater than or equal to [≥] 0.9). Participants with submassive PE will be randomized to one of four APT treatment groups: ultrasound of 2 and 6 hours (hrs) with r-tPA 2 milligrams (mg)/hr/catheter and ultrasound 4 and 6 hours with r-tPA, 1 mg/hr/catheter. On 08 June 2016, randomization into treatment group 4 (APT/6 hours-r-tPA/2 mg/hr/catheter) was closed following a reported intracranial hemorrhage (ICH) and death in a study participant in this arm.
Detailed description
This study is designed to investigate the lowest recombinant tissue plasminogen activator (r-tPA) dose-ultrasound treatment time required to achieve the same reductions in thrombus burden and associated improvement in physiologic parameters demonstrated in ULTIMA (EKOS 08 [NCT01166997]) and SEATTLE II (EKOS 09 [NCT01513759]). Results of this study are intended to inform the study design for further studies of the Acoustic Pulse Thrombolysis (APT) Procedure. Analysis of the first 100 evaluable participants in the United States study suggested a degree of equipoise between treatment groups 1, 2 and 3 of the protocol and therefore the sample size has been extended and additional sites in the United Kingdom (UK) National Health Service included, with a view to adding to the findings of the OPTALYSE study from sites in the UK and increasing the number of participants treated by treatment protocol.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 4
| Arm | Type | Receives |
|---|---|---|
| APT/2 Hours-r-tPA/2 mg/hr/Catheter | Experimental | Device: Ekosonic® Endovascular Device ultrasonic infusion catheter, Biological: Recombinant tissue plasminogen activatorA total of 4 or 8 mg r-tPA (as 2 mg/hour [hr]/catheter) will be delivered through Ekosonic® Endovascular Device (EKOS) ultrasonic infusion catheter for 2 hrs. |
| APT/4 Hours-r-tPA/1 mg/hr/Catheter | Experimental | Device: Ekosonic® Endovascular Device ultrasonic infusion catheter, Biological: Recombinant tissue plasminogen activatorA total of 4 or 8 mg r-tPA (as 1 mg/hr/catheter) will be delivered through EKOS ultrasonic infusion catheter for 4 hrs. |
| APT/6 Hours-r-tPA/1 mg/hr/Catheter | Experimental | Device: Ekosonic® Endovascular Device ultrasonic infusion catheter, Biological: Recombinant tissue plasminogen activatorA total of 6 or 12 mg r-tPA (as 1 mg/hr/catheter) will be delivered through EKOS ultrasonic infusion catheter for 6 hrs. |
| APT/6 Hours-r-tPA/2 mg/hr/Catheter | Experimental | Device: Ekosonic® Endovascular Device ultrasonic infusion catheter, Biological: Recombinant tissue plasminogen activatorA total of 12 or 24 mg r-tPA (as 2 mg/hr/catheter) will be delivered through EKOS ultrasonic infusion catheter for 6 hrs. |
Who may qualify
- Ages
- 18 to 75 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (6 listed)
- Male or female greater than or equal to (≥) 18 years of age and less than or equal to (≤) 75 years of age.
- CTA evidence of proximal PE (filling defect in at least one main or lobar pulmonary artery).
- PE symptom duration ≤14 days.
- Submassive PE: RV/LV diameter ≥ 0.9 from CTA and hemodynamically stable. For Participants in UK Sites: Submassive PE: RV/LV diameter ≥ 0.9 from CTA, hemodynamically stable and an elevated biomarker.
- Must be treated within 48 hours of diagnosis of PE by CTA.
Key exclusion criteria (17 listed)
- Stroke or transient ischemic attack (TIA), head trauma, or other active intracranial or intraspinal disease within one year.
- Recent (within one month) or active bleeding from a major organ.
- Major surgery within seven days of screening for study enrollment.
- Clinician deems the subject high-risk for catastrophic bleeding.
- History of heparin-induced thrombocytopenia (HIT).
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Ekosonic® Endovascular Device ultrasonic infusion catheterAlso: Acoustic Pulse Thrombolysis Procedure (APT Procedure), EKOSr-tPA will be administered via EKOS. | Device | APT/2 Hours-r-tPA/2 mg/hr/Catheter, APT/4 Hours-r-tPA/1 mg/hr/Catheter, APT/6 Hours-r-tPA/1 mg/hr/Catheter, APT/6 Hours-r-tPA/2 mg/hr/Catheter |
| Recombinant tissue plasminogen activatorAlso: r-tPARecombinant tissue plasminogen activator will be administered as per the dose and schedule specified in the arm. | Biological | APT/2 Hours-r-tPA/2 mg/hr/Catheter, APT/4 Hours-r-tPA/1 mg/hr/Catheter, APT/6 Hours-r-tPA/1 mg/hr/Catheter, APT/6 Hours-r-tPA/2 mg/hr/Catheter |
Primary outcome
Change From Baseline in the Right Ventricle (RV) Diameter-to-Left Ventricle (LV) Diameter Ratio to 48 ± 6 Hours After the Start of the APT Procedure
Time frame: Change from Baseline to 48 hrs ± 6 hours
Change from baseline in RV/LV will be determined by computed tomographic angiography (CTA).
Number of Participants With Major Bleeding Within 72 Hours After Initiating the APT Procedure
Time frame: Day 3 (within 72 hours after initiating the APT procedure)
Criteria for major bleeding events, as defined by the International Society on Thrombosis and Haemostasis (ISTH): 1. Fatal bleeding and/or; 2. Symptomatic bleeding in a critical area or organ (intracranial, intraspinal, intraocular, retroperitoneal, intra-articular or pericardial, or intramuscular with compartment syndrome) and/or; 3. Bleeding causing a fall in hemoglobin level of 20 grams/liter (g/L) or more, or leading to transfusion of two or more units of whole blood or red blood cells.
25 secondary outcomes
Percentage of Participants With Treatment Success of an APT Procedure
Time frame: From Baseline up to Day 30
Change From Baseline in RV/LV at Days 0, 2, 30, 90, and 365, as Assessed by Echocardiograph.
Time frame: Baseline (Day -2 [within -48 hrs of APT start]), Day 0 (within 4 hours after APT end), Day 2 (48 [± 6] hrs of APT start), Day 30 (± 5 days), Day 90 (± 10 days) and Day 365 (± 14 days)
Change From Baseline in Tricuspid Annular Plane Systolic Excursion (TAPSE) at Days 0, 2, 30, 90, and 365, as Assessed by Echocardiograph
Time frame: Baseline (Day -2 [within -48 hrs of APT start]), Day 0 (within 4 hours after APT end), Day 2 (48 [± 6] hrs of APT start), Day 30 (± 5 days), Day 90 (± 10 days) and Day 365 (± 14 days)
Change From Baseline in Estimated Right Ventricular Systolic Pressure (RVSP) at Days 0, 2, 30, 90, and 365, as Assessed by Echocardiograph
Time frame: Baseline (Day -2 [within -48 hrs of APT start]), Day 0 (within 4 hours after APT end), Day 2 (48 [± 6] hrs of APT start), Day 30 (± 5 days), Day 90 (± 10 days) and Day 365 (± 14 days)
Percentage of Participants With Collapse of the Inferior Vena Cava (IVC) With Respiration at Days 0, 2, 30, 90, and 365, as Assessed by Echocardiograph
Time frame: Baseline (Day -2 [within -48 hrs of APT start]), Day 0 (within 4 hours after APT end), Day 2 (48 [± 6] hrs of APT start), Day 30 (± 5 days), Day 90 (± 10 days) and Day 365 (± 14 days)
Change From Baseline in Thrombus Burden by Miller Score as Assessed by Pulmonary Arteriogram (PAgram) at Day 0
Time frame: Baseline, Day 0 (within 4 hours after APT end)
Change From Baseline in Thrombus Burden by Modified Miller Score as Assessed by CTA Scan at 48 ± 6 Hours After the Start of the APT Procedure
Time frame: From Baseline to 48 hrs ± 6 hours
Change in 6 Minute Walk (6MW) Distance From Day 30 to Day 90 and 365
Time frame: Days 30, 90, 365
Change in Borg Scale Score Before and After 6MW Distance Test at Days 30, 90, and 365
Time frame: Days 30, 90, and 365
Number of Participants Who Received Oxygen Therapy
Time frame: Days 30, 90, and 365
Change in Participant Reported Outcomes Measurement Information System Physical Function (PROMIS-PF) 6b Score From Day 30 to Day 365
Time frame: Day 30, Day 365
Change in Pulmonary Embolism Quality of Life (PEmb-QOL) Score From Day 30 to Day 365
Time frame: Day 30, Day 365
Number of Participants Who Encountered Technical Procedural Complications
Time frame: From device placement through Day 2
Number of Participants With Symptomatic Recurrent Pulmonary Embolism (Per Adjudication)
Time frame: From Baseline up to Day 365
Number of Participants Who Die Due to Any Cause
Time frame: From Baseline up to Day 365
For Participants of UK Sites: Freedom From Major Harm Occurring Between Enrolment and 30 Days
Time frame: From Baseline up to Day 30
For Participants of UK Sites:Change in EuroQual - 5 Dimensions - 5 Levels (EQ-5D-5L) Score From Day 30 to Day 365
Time frame: Day 30, Day 365
For Participants of UK Sites: Time From Hospital Admission to Diagnosis of PE
Time frame: From Baseline through Day 3
For Participants of UK Sites: Time From Diagnostic Computed Tomography (CT) Scan to Initiation of Treatment for PE
Time frame: From Baseline through Day 3
For Participants of UK Sites: Time in Each Level of Care (Level 0 and 1; Level 2; and/or Level 3) Through Discharge
Time frame: From Baseline up to Hospital Discharge
Healthcare Resource Utilization: Team Managing the Participant During Hospitalization - Number of Healthcare Professional (HCP) Specialties Involved. (UK Participants Only)
Time frame: From Baseline up to Day 365
Healthcare Resource Utilization: Number of Healthcare Professionals (HCP) Visits for Venous Thromboembolism (VTE) After Hospitalization and During 12month Follow-up. (UK Participants Only)
Time frame: From Day 30 up to Day 365
Healthcare Resource Utilization: Number of Healthcare Professionals (HCP) Visits for Venous Thromboembolism (VTE) After Hospitalization and During 12 Month Follow-up. (UK Participants Only)
Time frame: From Day 30 up to Day 365
Healthcare Resource Utilization: Number of Hospital Re-Admissions After Hospitalization and During 12 Month Follow-up. (UK Participants Only)
Time frame: From Day 30 up to Day 365
Healthcare Resource Utilization: Duration of Hospital Re-Admissions After Hospitalization and During 12 Month Follow-up. (UK Participants Only)
Time frame: From Day 30 through Day 365
Results and safety
Loading the posted results from ClinicalTrials.gov…
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 19 Jul 2021.
- Posted resultsParticipant flow, baseline, all outcome measures and adverse events.
- Background: PubMed 32757658Piazza G, Sterling KM, Tapson VF, Ouriel K, Sharp ASP, Liu PY, Goldhaber SZ. One-Year Echocardiographic, Functional, and Quality of Life Outcomes After Ultrasound-Facilitated Catheter-Based Fibrinolysis for Pulmonary Embolism. Circ Cardiovasc Interv. 2020 Aug;13(8):e009012. doi: 10.1161/CIRCINTERVENTIONS.120.009012. Epub 2020 Aug 6.
- Results publication: PubMed 30025734Tapson VF, Sterling K, Jones N, Elder M, Tripathy U, Brower J, Maholic RL, Ross CB, Natarajan K, Fong P, Greenspon L, Tamaddon H, Piracha AR, Engelhardt T, Katopodis J, Marques V, Sharp ASP, Piazza G, Goldhaber SZ. A Randomized Trial of the Optimum Duration of Acoustic Pulse Thrombolysis Procedure in Acute Intermediate-Risk Pulmonary Embolism: The OPTALYSE PE Trial. JACC Cardiovasc Interv. 2018 Jul 23;11(14):1401-1410. doi: 10.1016/j.jcin.2018.04.008.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Victor Tapson, MD principal investigator
Cedar Sinai, Los Angeles
21 sites in 2 countries: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 4 study testing Ekosonic® Endovascular Device ultrasonic infusion catheter and Recombinant tissue plasminogen activator in people with Pulmonary Embolism and Thrombosis, run by Boston Scientific Corporation at 21 sites in 2 countries.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 6 inclusion and 17 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 19 Jul 2021. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 21 sites in United States, United Kingdom. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
Yes. Results are posted in the registry (first posted 2 Mar 2021). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Change From Baseline in the Right Ventricle (RV) Diameter-to-Left Ventricle (LV) Diameter Ratio to 48 ± 6 Hours After the Start of the APT Procedure (time frame: Change from Baseline to 48 hrs ± 6 hours). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT02396758, which also lists 2 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 19 Jul 2021; AzTrials last refreshed its copy on 8 Nov 2026.