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Coronary Artery DiseaseROTA-CUTNCT04865588

Rotational Atherectomy Combined With Cutting Balloon to Optimize Stent Expansion in Calcified Lesions

A study testing rotational atherectomy, cutting balloon and plain old balloon in people with Coronary Artery Disease and Atherosclerosis, run by Samin Sharma, M.D., F.A.C.C., M.S.C.A.I. at 2 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Rotational atherectomy is an established tool to treat blocked arteries in the heart, in which the blockage is due to significant amounts of calcified material. In rotational atherectomy, a rotating instrument is used to break up the calcification before a stent is placed and helps restore blood flow to the heart. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Coronary Artery Disease, Atherosclerosis
What is being tested?
rotational atherectomy, cutting balloon and plain old balloon
Could I receive a placebo?
No, everyone receives an active treatment
How many people
60 participants
Where
2 sitesUnited States
Study dates
13 May 2022to 12 Dec 2023
Phase
Interventional
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 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Adults Patients ≥18 years of age
  • Patients undergoing percutaneous coronary intervention with planned rotational atherectomy and planned drug-eluting stent implantation of a lesion with target vessel reference diameter ≥2.5 mm and ≤ 4.0mm, lesion length ≥ 5 mm and moderate to severe calcification by angiography
  • Patients eligible for percutaneous coronary intervention

Who cannot join

  • Patients in cardiogenic shock
  • Planned surgery (cardiac and non-cardiac) within 6 months after the index procedure unless the dual-antiplatelet therapy can be maintained throughout the perisurgical period
  • Patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction
  • Subject is pregnant, nursing, or is a woman of child-bearing potential who is not surgically sterile, < 2 years postmenopausal, or does not consistently use effective methods of contraception
  • Patient has any other serious medical illness (e.g., cancer, end-stage congestive heart failure) that may reduce life expectancy to less than 12 months
  • Currently participating in another investigational drug or device study
Show all 15Show fewer
  • Patients referred to coronary artery bypass grafting after heart team discussion
  • Angiographic Specific Exclusion Criteria:
  • Lesion(s) with angulation > 45 degrees by visual estimate
  • Lesion(s) stenosis through which a guidewire will not pass.
  • Last remaining vessel with compromised (<30%) left ventricular function
  • Saphenous vein grafts
  • Angiographic evidence of thrombus
  • Angiographic evidence of significant dissection at the treatment site
  • Lesion(s) with previously placed stent within 10 mm (visual estimate)

Trial locations and contacts

2 sites in 1 country.

United States2 sites
  • The Icahn School of Medicine at Mount Sinai

    New York, New York, 10029

  • Saint Francis Hospital and Heart Center

    Roslyn, New York, 11576

Other trials in United States

About this study

Rotational atherectomy is an established tool to treat blocked arteries in the heart, in which the blockage is due to significant amounts of calcified material. In rotational atherectomy, a rotating instrument is used to break up the calcification before a stent is placed and helps restore blood flow to the heart. However, severely calcified regions are difficult to treat and even after treatment arteries can re-clog and major cardiac events occur. This study will test if rotational atherectomy with the addition of a cutting balloon - a balloon with microsurgical blades on its outer surface which make longitudinal incisions in the calcified area in order to open resistant clogs - will result in increased blood vessel lumen, more optimal stent expansion and decreased cardiac problems compared to current standard treatment.

Read the detailed description

This is a prospective, pilot study randomizing patients with stable Coronary Artery Disease undergoing Percutaneous Coronary Intervention for a de novo calcified lesion with drug eluting stent implantation to angioplasty with rotational atherectomy followed by cutting balloon (ROTA + CBA) or rotational atherectomy followed by plain old balloon (ROTA + POBA) in a 1:1 ratio.

The clinical investigation will be conducted at 2 centers in the US. Up to 48 randomized subjects per site will be enrolled in this study. Subjects participating in this clinical investigation will be followed for 9 months. The expected duration of enrollment is approximately 6 months. The total duration of the clinical investigation is expected to be approximately 2 years.

Being tested
rotational atherectomy, cutting balloon, plain old balloon
Keywords
calcified plaque, angioplasty, cutting balloon
Medical subject headings
Coronary Artery Disease, Atherosclerosis

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • rotational atherectomyProcedure or surgery

    angioplasty with rotational atherectomy - a rotating instrument used to break up the calcification

  • cutting balloonDevice

    a balloon with microsurgical blades on its outer surface which make longitudinal incisions in the calcified area in order to open resistant clogs

  • plain old balloonDevice

    current standard treatment of stent placement

Study groups in NCT04865588
Study groupRoleWhat they receive
rotational atherectomy + cutting balloonActive comparatorangioplasty with rotational atherectomy followed by cutting balloon
Receives: Procedure: rotational atherectomy; Device: cutting balloon
rotational atherectomy + plain old balloonActive comparatorangioplasty with rotational atherectomy followed by plain old balloon
Receives: Procedure: rotational atherectomy; Device: plain old balloon

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Minimum Stent Area After Percutaneous Coronary Intervention

    Post-procedure minimum stent area after percutaneous coronary intervention assessed by intravascular ultrasound (IVUS)

    Measured: Post-procedure, Day 0

Secondary outcomes (30)
  1. In-segment Minimum Lumen Area After Stent Implantation and Post Dilatation

    In-segment Minimum lumen area after stent implantation and post dilatation assessed by intravascular ultrasound

    Measured: Post-procedure, Day 0

  2. Minimum Percent Stent Expansion After Percutaneous Coronary Intervention

    Minimum percent stent expansion after Percutaneous Coronary Intervention assessed by intravascular ultrasound

    Measured: Post-procedure, Day 0

  3. Mean Percent Stent Expansion After Percutaneous Coronary Intervention

    Mean percent stent expansion after percutaneous coronary intervention assessed by intravascular ultrasound

    Measured: Post-procedure, Day 0

  4. Number of Participants With Dissection After Percutaneous Coronary Intervention

    Number of Participants with Dissection after Percutaneous Coronary Intervention assessed by intravascular ultrasound.

    Measured: Post-procedure, Day 0

  5. Number of Participants With Stent Malapposition After Percutaneous Coronary Intervention

    Number of Participants with Stent malapposition after Percutaneous Coronary Intervention assessed by intravascular ultrasound. Malapposition is indicated by blood visible behind stent struts. Stents may be completely or only partially malapposed depending on how much of the stent is in contact with the lumen wall.

    Measured: Post-Procedure, Day 0

  6. Number of Participants With Dissection After Rotational Atherectomy and Cutting Balloon Angioplasty /Non-compliant Balloon Angioplasty (CBA/NCBA)

    Number of Participants with Dissection after Rotational atherectomy and cutting balloon angioplasty /non-compliant balloon angioplasty (CBA/NCBA) assessed by intravascular ultrasound. A dissection or tear in the vessel wall

    Measured: Post-CBA/NCBA before stent, Day 0

  7. Number of Participants With a Calcium Fracture After Rotational Atherectomy and Cutting/Plain Old Balloon

    Number of Participants with a Calcium fracture after Rotational atherectomy and Cutting/Plain old balloon assessed by intravascular ultrasound. A fracture within the calcified area.

    Measured: Post-Procedure, Day 0

  8. Acute Lumen Gain In-segment After Stent Implantation Assessed by Angiography

    Defined as the minimal luminal diameter in stent after stent implantation minus the minimal luminal diameter at baseline (prior to percutaneous coronary intervention and/or prior to stent placement).

    Measured: Post-procedure, Day 0

  9. Acute Lumen Gain In-stent After Stent Implantation Assessed by Angiography

    Defined as the minimal luminal diameter in segment after stent implantation minus the minimal luminal diameter at baseline (prior to percutaneous coronary intervention and/or prior to stent placement).

    Measured: Post-procedure, Day 0

  10. Percent Residual Diameter Stenosis In-segment After Stent Implantation

    Percent Residual diameter stenosis in-segment after stent implantation assessed by Angiography

    Measured: Post-procedure, Day 0

  11. Percent Residual Diameter Stenosis In-stent After Stent Implantation

    Percent Residual diameter stenosis in-stent after stent implantation assessed by Angiography

    Measured: Post-procedure, Day 0

  12. Minimum Lumen Diameter In-segment After Stent Implantation

    Minimum lumen diameter in-segment after stent implantation assessed by Angiography

    Measured: Post-procedure, Day 0

  13. Minimum Lumen Diameter In-stent After Stent Implantation

    Minimum lumen diameter in-stent after stent implantation assessed by Angiography

    Measured: Post-procedure, Day 0

  14. Number of Participants With Dissection Type B or Greater

    Number of Participants with Dissection Type B or greater before and after stent implantation assessed by Angiography.

    Measured: Post-CBA/NCBA before stent and after stent, Day 0

  15. Number of Participants With Perforation (Ellis Type ≥2) After Stent Implantation

    Number of Participants with perforation (Ellis type ≥2) after stent implantation assessed by Angiography. Perforation of a vessel

    Measured: Post-procedure, Day 0

  16. Number of Participants With Side Branch Closure After Stent Implantation

    Number of Participants with side branch closure after stent implantation assessed by Angiography. Occlusion of a side branch

    Measured: Post-procedure, Day 0

  17. Number of Participants With a Balloon Rupture

    Device problem; Rupture of the cutting balloon or plain old balloon

    Measured: Post-Procedure, Day 0

  18. Number of Participants With Blade Detachment

    Device problem; detachment of a blade from the cutting balloon

    Measured: Post-Procedure, Day 0

  19. Number of Participants With Difficulty in Withdrawing/Advancing the Device

    Device problem; difficulty in moving the balloon within the vessel during the procedure

    Measured: Post-Procedure, Day 0

  20. Number of Participants Who Died of All-causes (Cardiac and Non-cardiac) After Percutaneous Coronary Intervention

    Measured: 30 days

  21. Number of Participants Who Died of Cardiac Death After Percutaneous Coronary Intervention

    Cardiac Death

    Measured: 30 days

  22. Number of Participants Who Died of Non-Cardiac Death After Percutaneous Coronary Intervention

    Non-Cardiac Death

    Measured: 30 days

  23. Number of Participants With Myocardial Infarction, as Defined by the Society for Cardiovascular Angiography and Intervention (SCAI), After Percutaneous Coronary Intervention

    The Society for Cardiovascular Angiography and Intervention (SCAI) defines clinically relevant MI after PCI as an elevation of cardiac biomarkers (CK-MB or troponin) above specified thresholds within 48 hours of the procedure, with or without new Q waves or LBBB on ECG. This definition aims to identify meaningful ischemic injury to the myocardium that is associated with adverse clinical outcomes.

    Measured: 30 days

  24. Percent of Participants With Myocardial Infarction, as Defined by 4th Universal Definition, After Percutaneous Coronary Intervention

    Myocardial infarction is defined as heart muscle damage due to lack of blood flow, based on characteristic symptoms, ECG changes, and cardiac biomarker elevation, especially troponin. Elevated levels of cardiac biomarkers, especially troponin, along with ECG changes and cardiac symptoms, indicate myocardial infarction according to the universal definition.

    Measured: 30 days

  25. Number of Participants With Target Lesion Revascularization After Percutaneous Coronary Intervention

    Revascularization

    Measured: 30 days

  26. Number of Participants With Target Vessel Revascularization After Percutaneous Coronary Intervention

    Revascularization

    Measured: 30 days

  27. Number of Participants With Stent Thrombosis (Definite/Probable) After Percutaneous Coronary Intervention

    Stent Thrombosis

    Measured: 30 days

  28. Number of Participants With Major Bleeding (BARC 3 or 5) After Percutaneous Coronary Intervention

    Bleeding Academic Research Consortium (BARC) Type 3

    1. Overt bleeding plus hemoglobin drop of 3 to < 5 g/dL (provided hemoglobin drop is related to bleed); transfusion with overt bleeding
    2. Overt bleeding plus hemoglobin drop < 5 g/dL (provided hemoglobin drop is related to bleed); cardiac tamponade; bleeding requiring surgical intervention for control; bleeding requiring IV vasoactive agents
    3. Intracranial hemorrhage confirmed by autopsy, imaging, or lumbar puncture; intraocular bleed compromising vision

    Type 5

    1. Probable fatal bleeding
    2. Definite fatal bleeding (overt or autopsy or imaging confirmation)

    Measured: 30 days

  29. Number of Participants With Vascular Complications After Percutaneous Coronary Intervention

    Vascular complication

    Measured: 30 days

  30. Angina Status According to Canadian Cardiovascular Society (CSS) Classification

    The Canadian Cardiovascular Society (CCS) grading scale is a classification system used to grade the severity of angina pectoris based on symptoms and their relationship to physical activity.

    Grade I: Ordinary physical activity like walking does not cause angina. Angina only occurs with strenuous, rapid, prolonged exertion during recreation or work.

    Grade II: Slight limitation of ordinary activity. Angina occurs when walking/climbing stairs rapidly, walking uphill, after meals, in cold/wind, under stress, or early morning. Angina occurs when walking more than 2 blocks or climbing more than 1 flight of stairs at a normal pace.

    Grade III: Marked limitation of ordinary activity. Angina occurs when walking 1-2 blocks or climbing 1 flight of stairs at a normal pace.

    Grade IV: Inability to carry out any physical activity without angina. Anginal symptoms may be present at rest.

    Higher grades indicate more limitations to activity due to angina.

    Measured: 270 days

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted29 Apr 2021
  2. Study start13 May 2022
  3. Primary completion4 Apr 2023
  4. Study completion12 Dec 2023

Resources

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 N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Parallel Assignment
Masking
None (open label)
Enrolment
60 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04865588
Sponsor's protocol ID
GCO 21-0532
Acronym
ROTA-CUT
Status last verified
Apr 2024
First submitted
14 Apr 2021
Last updated
22 May 2024
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
Yes
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A study testing rotational atherectomy, cutting balloon and plain old balloon in people with Coronary Artery Disease and Atherosclerosis, run by Samin Sharma, M.D., F.A.C.C., M.S.C.A.I. at 2 sites in United States.

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 3 inclusion and 15 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 22 May 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in United States. 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.

Are results available for this study?

Yes. Results are posted in the registry (first posted 22 May 2024). 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?

Minimum Stent Area After Percutaneous Coronary Intervention (time frame: Post-procedure, Day 0). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 22 May 2024.

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