Comparing drug-coated balloons and drug-eluting stents for large coronary artery blockages

LARGE-ONE: A Prospective, Multicenter, Randomized Controlled Trial of the Use of Drug-coating Balloons(DCB) or Drug-eluting Stents(DES) in the Treatment of Large Diameter Coronary Atherosclerotic Lesions

This study is testing whether a new type of balloon treatment for large coronary artery blockages works as well as a standard stent treatment for patients with heart disease.

Quick facts

• Phase: Not applicable
• Study type: Interventional
• Enrollment: 134 (estimated)
• Ages: 18 Years to 75 Years
• Sex: All
• Sponsor: Shanghai MicroPort Medical (Group) Co., Ltd. (Industry-sponsored)
• Locations: 1 site (Jining, Shandong)
• Trial ID: NCT05961787 on ClinicalTrials.gov

What this trial studies

This trial evaluates the effectiveness of drug-coated balloons (DCB) compared to drug-eluting stents (DES) in treating large-diameter coronary atherosclerotic stenosis through percutaneous coronary intervention (PCI). It focuses on patients with symptomatic coronary artery disease and aims to determine if DCB is non-inferior to DES in managing this condition. Participants will undergo treatment with either a SeQuent® Please drug-coated balloon or a Firehawk™ drug-eluting stent. The study specifically targets lesions in coronary arteries with diameters between 3.00 mm and 4.00 mm.

Who should consider this trial

Good fit: Ideal candidates are adults aged 18-75 with symptomatic coronary artery disease and suitable for PCI.

Not a fit: Patients with lesions not meeting the specified criteria or those with severe comorbidities may not benefit from this study.

Why it matters

Potential benefit: If successful, this study could provide a less invasive treatment option for patients with large coronary artery blockages.

How similar studies have performed: Previous studies have shown promising results with drug-coated balloons in similar contexts, indicating potential for success in this approach.

Eligibility criteria

Inclusion Criteria:

CI1. Age of subject 18-75 years old;

CI2. The subject (or legal guardian) understands and provides written informed consent to the test requirements and treatment procedures prior to performing any specific tests or procedures in the study;

CI3. The subject is suitable for percutaneous coronary intervention (PCI);

CI4. The subject had symptomatic coronary artery disease with objective evidence or asymptomatic ischemia;

CI5. Subject is willing to submit to all subsequent evaluations required by the test protocol

Angiogragh Inclusion

AI1. At Maximum 2 target lesions with stenosis ≥50%, located in no more than 2 vessels with a visual reference vessel diameter (RVD) of ≥3.00 mm and ≤4.00 mm;

AI2. The length of the target lesion must be≤35 mm (visually) and can be covered by one study stent or drug balloon;

AI3. The first target lesion must be successfully predilated/pretreated without:

1. Vascular tears affecting hemodynamics (TIMI blood grade ≤2);
2. Coronary dissection classified as D, E and F(ARC);
3. Residual stenosis \> 30% after lesion preparation;

Note: If Type C dissection occurs at lesion predilation/preparation, clinical investigators will determine whether the target lesion can be included based on the comprehensive situation of blood flow and patients risks . Type C dissection will be excluded from the OCT subgroup considering the risk of dissection extension for OCT operation.

AI4. The anatomical conditions of the coronary artery were appropriate, and the study instrument could be transported to the appropriate location of the target lesion.

Exclusion Criteria:

CE1. Subjects with clinical symptoms and/or ECG findings consistent with the diagnosis of acute ST-segment elevation myocardial infarction (STEMI) within 7 days;

CE2. Subject is known to be allergic to contrast agents (which cannot be fully pretreated) and/or concomitant medications required by the stent system or protocol (e.g., cobalt-chrome, platinum-chrome, stainless steel, rapamycin, paclitaxel and similar configuration compounds, drug coating carrier components, all P2Y12 receptor inhibitors, aspirin, etc.);

CE3. Planned surgical treatment within 6 months after baseline surgery;

CE4. Severe heart failure (NYHA Grade IV) or left ventricular ejection fraction \<30% (ultrasound or left ventricular contrast);

CE5. Previous renal impairment: serum creatinine \>2.0mg/dL; Or on dialysis;

CE6. Previous bleeding events (BARC III or V);

CE7. Subject is receiving or indication of long-term anticoagulant therapy ;

CE8. Subject has any of the following conditions (baseline assessment) :

* Other serious medical conditions that reduce subjects' life expectancy to less than 13 months (e.g., cancer, congestive heart failure);
* Subject has a current substance abuse problem (e.g., alcohol, cocaine, heroin, etc.);
* Subject plans to undergo surgical/intervention procedures that may result in non-compliance with protocol or confusing data interpretation;

CE9. Subject has a history of bleeding tendency, coagulation disorders or refusal of blood transfusion;

CE10. The subject is participating in a clinical trial of another investigational drug or device that does not meet its primary endpoint;

CE11. Subjects are scheduled to participate in another investigational drug or device clinical trial within 13 months of baseline procedure;

CE12. Subjects who intend to be pregnant within 13 months of baseline procedure (fertile and sexually active women should consent to use a reliable contraceptive method from screening to 13 months after baseline surgery);

CE13. Subjects are pregnant or breastfeeding (fertile women with pregnancy possibility should undergo a pregnancy test within 7 days prior to baseline surgery).

Angiogragh Exclusion

AE1. Plan to treat 3 or more target lesions;

AE2. Plan to treat more than 2 major epicardial vessels;

AE3. A single lesion to be treated cannot be covered by a single stent or a single drug balloon;

AE4. The subject had two target lesions in the same target vessel, and the distance between the two target lesions was ≤15mm (visual observation);

AE5. Target lesions were located in the left main trunk;

AE6. Target lesions were located within 3mm of the initial segment of the left anterior descending artery (LAD) or left circumflex artery (LCX).

AE7. Target lesions were located in a saphenous vein, artery or artificial bypass graft;

AE8. Target lesions need to be treated through a saphenous vein, artery or artificial bypass graft ;

AE9. Target lesion blood flow grade of TIMI 0/1 before guide wire passes through ;

AE10. Treatment of target lesions involves multi-stent strategy in complex lesions (e.g., bifurcated lesions require more than one stent);

AE11. Target lesions involve previously in-stent restenosis lesions or overlap with previously implanted stents;

AE12. Subject has unprotected left main coronary artery disease (\>50% diameter stenosis);

AE13. Subjects have received PCI for any type of target lesion (e.g., balloon dilation, stent placement, balloon dissection, etc.) within 12 months before baseline;

AE14. Presence of thrombus or possible thrombus in the target lesion (visual);

AE15. The target lesions were moderate to severe calcification lesions.

Where this trial is running

Jining, Shandong

• Jining Medical University Affiliated Hospital — Jining, Shandong, China (Recruiting)

Study contacts

• Study coordinator: Lijun Gan, doctoral

Conditions Coronary Artery Disease