CABERNET: Carotid Artery Revascularization Using the Boston Scientific EPI Filter Wire EZ™ and the EndoTex™ NexStent™

Sponsor

Boston Scientific Corporation (Industry)

Overall Status

Completed

CT.gov ID

NCT00600327

Collaborator

(none)

488

Enrollment

Locations

Arm

Duration (Months)

25.7

Patients Per Site

0.4

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

The primary objective of this study is to demonstrate the safety of the NexStent for treatment of carotid artery lesions undergoing stenting with adjunctive use of the FilterWire distal embolic protection device. The rates will be compared to an Objective Performance Criterion (OPC) derived from historic data from high-risk patients undergoing surgical intervention with Carotid endarterectomy. Patients included in this study are those at higher risk for complications associated with CEA.

Condition or Disease	Intervention/Treatment	Phase
Transient Ischemic Attack Thromboembolic Stroke Stroke Prevention	Device: EndoTex™ NexStent™ Device: Filter Wire EZ™	Phase 3

Study Design

Study Type:

Interventional

Actual Enrollment :

488 participants

Allocation:

Non-Randomized

Intervention Model:

Single Group Assignment

Masking:

None (Open Label)

Primary Purpose:

Treatment

Official Title:

Carotid Artery Revascularization Using the Boston Scientific EPI Filter Wire EZ™ and the EndoTex™ NexStent™

Study Start Date :

Dec 1, 2001

Actual Primary Completion Date :

Mar 1, 2005

Actual Study Completion Date :

Jun 1, 2007

Arms and Interventions

Arm	Intervention/Treatment
Experimental: 1	Device: EndoTex™ NexStent™ EndoTex™ NexStent™ is a flexible, fine mesh Nitinol stent used to treat patients that are at high risk of adverse events from carotid endarterectomy and require carotid revascularization of a target vessel that has a reference diameter between 4mm and 9mm and stenosis that is less than 30mm in length. Device: Filter Wire EZ™ EPI Fliter Wire EZ™ Embolic Protection System is indicated for use as a guide wire and embolic protection system to contain and remove embolic material (thrombus/debris) while performing angioplasty and stenting procedures in coronary saphenous vein bypass grafts and carotid arteries.

Arm

Intervention/Treatment

Experimental: 1

Device: EndoTex™ NexStent™

EndoTex™ NexStent™ is a flexible, fine mesh Nitinol stent used to treat patients that are at high risk of adverse events from carotid endarterectomy and require carotid revascularization of a target vessel that has a reference diameter between 4mm and 9mm and stenosis that is less than 30mm in length.

Device: Filter Wire EZ™

EPI Fliter Wire EZ™ Embolic Protection System is indicated for use as a guide wire and embolic protection system to contain and remove embolic material (thrombus/debris) while performing angioplasty and stenting procedures in coronary saphenous vein bypass grafts and carotid arteries.

Outcome Measures

Primary Outcome Measures

Major clinical events at one-year defined as any death, stroke or myocardial infarction [1 year]
30-day event rate defined as any death, stroke or myocardial infarction less than or equal to 30-days post-procedure; plus the 31-day to 12-month event rate defined as any ipsilateral stroke including any death as a result of an ipsilateral stroke. [1 year]

Secondary Outcome Measures

NexStent™ technical success [post surgery]
FilterWire EZ™ technical success [post surgery]
Overall system technical success [post surgery]
Angiographic success [post procedure]
Procedure Success [24 hours post procedure]
Restenosis [1 year]
Target vessel revascularization [1 year]

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

patient is greater than or equal to 18 years of age.
Anticipated patient life expectancy is of at least one year from the date of the index procedure.
Lesion is located in the common carotid artery (CCA) and/or the internal carotid artery (ICA) or the carotid bifurcation.
Target vessel is the only vessel being treated at this intervention and the lesion is less than or equal to 30 mm and can be treated with a single stent.
Vessel to be treated is between 4.0 mm and 9.0 mm in diameter.
Patient can be either symptomatic or asymptomatic; Symptomatic: Stenosis must be greater than or equal to 50% as determined by angiogram and the patient has a history of stroke, TIA and/or amaurosis fugax in the hemisphere supplied by the target vessel within 180 days of the procedure.
Patient can be either symptomatic or asymptomatic; Asymptomatic: Stenosis must be greater than or equal to 60% as determined by angiogram without any neurological symptoms.
Distal vessel "landing zone" for placement of the FilterWire must be between 3.5 mm and 5.5 mm in diameter with visual angiographic recommendations as described in the IFU.
Female patients with no childbearing potential or a documented negative pregnancy test (urine or blood) within 10 days of the index procedure.
Patient (or their legal guardian) understands the nature of the procedure and has provided a signed informed consent using a form that has been reviewed and approved by the Investigational Review Board/Ethics Committee of the respective clinical site prior to the procedure. This will be obtained prior to participation in the study.
Patient is willing to comply with the protocol requirements and return to the treatment center for all required clinical evaluations
Patient must fulfill at least one of the following Class I: Unstable angina, LVEF less than 30%, CHF class III or class IV, dialysis dependent renal failure, severe COPD, requirement for staged CABG or valve replacement post carotid index procedure,Previous carotid endarterectomy with significant restenosis, total occlusion of the contralateral carotid artery, Previous radiation treatment to the neck or radical neck dissection, Target lesion is at or above the second vertebral body C2 or below the clavicle, Inability to extend the head due to cervical arthritis or other cervical disorders, Tracheostomy or tracheal stoma,Presence of laryngeal nerve palsy, Bilateral carotid artery stenosis as determined by angiography.
If a patient does not meet Class I criteria, a patient must meet two of the follwing class II criteria: Patient is greater than or equal to 75 years of age, Myocardial infarction within previous 6 weeks, Requires staged peripheral vascular surgery (i.e. abdominal aortic aneurysm repair) or other major surgery post carotid index procedure, Two or more proximal or major diseased coronary arteries with greater than or equal to 70% stenosis that have not or cannot be revascularized.

Exclusion Criteria:

Previously placed stent in target vessel.
Total occlusion of target vessel (ICA or CCA).
Angiographically visible thrombus.
Carotid string sign (a tiny, long segment of contrast in the true lumen of the artery, aneurysmal pouch formation, and the distal location of the arteriopathy) with poor visualization of the distal vessel.
Vertebrobasilar insufficiency symptoms only, without clearly identifiable symptoms referable to the targeted carotid artery.
Vessel anatomy precluding use of stent system or distal protection system.
Presence of carotid artery dissection.
Requirement for staged CABG, valve replacement or abdominal aortic aneurysm procedure 30 days before or after the index procedure.
Evidence of a major disabling stroke within the previous 30 days.
Patient has an evolving stroke or has experienced a major stroke (NIHSS score greater than or equal to 15) within 3 months.
History of intracranial hemorrhage within the past 12 months.
Any condition that precludes proper angiographic assessment or makes percutaneous arterial access unsafe, e.g. morbid obesity, history of chronic hypertension that is not controlled by medical therapy.
Contraindication to heparin, aspirin, clopidogrel (Plavix®), X-ray contrast or ticlopidine (Ticlid®)in cases of intolerance to clopidogrel.
History of liver failure with elevated prothrombin time.
History or current indication of bleeding diathesis or coagulopathy.
Hgb <8 gm/dl (unless on dialysis), platelet count < 50,000, WBC >15,000, INR > l.5 (irreversible) or heparin-associated thrombocytopenia.
Known cardiac sources of emboli not under treatment with anticoagulant therapy.
Atherosclerotic disease involving adjoining vessels precluding safe placement of the guiding catheter or sheath.
Planned treatment of non-target lesion within 30 days.
Other abnormal angiographic findings that indicate the patient is at risk of a stroke due to a problem other that the target lesion, such as: ipsilateral arterial stenosis greater in severity than the target lesion, cerebral aneurysm, or arteriovenous malformation (AVM) of the cerebral vasculature.
Dementia or confusion.
The patient is enrolled in another study protocol.
Patient may not participate in another investigational trial up to 12 months post-index procedure.

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	St. Joseph's Hospital and Medical Center	Phoenix	Arizona	United States	85013
2	El Camino Hospital	Mountain View	California	United States	94040
3	Hoag Hospital	Newport Beach	California	United States	92663
4	Oschner Clinic Foundation	New Orleans	Louisiana	United States	70121
5	Union Memorial Hospital	Baltimore	Maryland	United States	21218
6	Albany Medical College	Albany	New York	United States	12208
7	Millard Fillmore Gates Hospital	Buffalo	New York	United States	14209
8	Columbia - Weill Cornell Division of Vascular Surgery	New York	New York	United States	10021
9	Lenox Hill Hospital	New York	New York	United States	10021
10	Carolina Medical Center	Charlotte	North Carolina	United States	28203
11	Cleveland Clinic Foundation	Cleveland	Ohio	United States	44195
12	Harrisburg Hospital	Harrisburg	Pennsylvania	United States	17101
13	University of Pittsburgh (UPMC-Shadyside)	Pittsburgh	Pennsylvania	United States	15232
14	Allegheny General Hospital	Pittsburg	Pennsylvania	United States	15212
15	Swedish Medical Center	Seattle	Washington	United States	98104
16	Favaloro Institute	Buenos Aires		Argentina	1093
17	Cardiovascular Center Bethanien, Germany	Frankfurt		Germany	60389
18	Leipzig Heart Center	Leipzig		Germany	04289
19	Sieburg Heart Center, Germany	Siegburg		Germany	53721