Clinical trial NCT01278303: Covered CP Stents for the Prevention or Treatment of Aortic Wall Injury Associated With Coarctation of the Aorta
Official title: Covered Cheatham Platinum Stents for the Prevention or Treatment of Aortic Wall Injury Associated With Coarctation of the Aorta
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE2
Conditions: Aortic Coarctation
Keywords: Coarctation
Aorta
Lead sponsor: Johns Hopkins University
Sponsor class: OTHER
Collaborators: name: Harvard University
First posted: 2011-01-17
Enrollment: 82
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: TREATMENT

Brief summary: Coarctation of the aorta (CoA) is a congenital abnormality producing obstruction to blood flow through the aorta. Coarctation can occur in isolation, in association with bicuspid aortic valve or with major cardiac malformations. CoA accounts for 5-8% of the 8/1000 (4-6/10,000) children born with congenital heart disease. Most CoA is newly diagnosed in childhood; \< 25% recognized beyond 10 yrs.

CoA is mostly repaired in childhood by surgery or by balloon catheter dilation. Recurrence rates range from 5-20%. Recurrence is often not recognized until adolescence. Balloon expandable stents have become the predominant therapy in the USA and Europe for CoA treatment in this age group. There are no FDA approved stents for this use. Biliary stents are currently being used off label. Enrollment into a trial of bare metal Cheatham Platinum (CP) Stents, designed for use in CoA, is completed. The Coarctation of the Aorta Stent Trial (COAST) aims to confirm safety and efficacy of CP Stent for native and recurrent CoA.

There are CoA patients with clinical situations that place them at high risk of aortic wall injury during bare metal stenting. Extreme narrowing, genetic aortic wall weakness and advanced age are examples. Patients may present with aortic wall injury (aneurysm) related to prior CoA repair. The occurrence after surgical repair is 3-4% and after balloon dilation 10-20%. Repair of these aneurysms is surgically challenging. The use of fabric-covered CP Stents to prevent or repair aortic wall injury has become the treatment of choice in Europe and recently in the US through the FDA Compassionate Use process. There are no alternative devices available in the US. COAST II will test safety and efficacy of Covered CP Stents to repair or prevent aortic wall injury associated with CoA.

Funding Source-FDA OOPD

Detailed description: There are no prior trials of preventing or treating aortic injury associated with CoA and thus no basis for comparison. A single outcome assessment will not suffice since patients can receive a device for either indication. A 3-category Severity of Illness Scale (SIS) was developed based on clinical judgment of a panel of pediatric cardiologists and reviewed by a Data \& Safety Monitoring Board (DSMB) and the FDA Office of Device Evaluation. Five levels of severity have been defined for each of the 3 illness categories, including: Upper extremity hypertension, Upper to lower extremity pressure difference, and Severity of aortic wall injury. The DSMB will assign a level of illness from the SIS for each patient at baseline and one year follow up. Improvement by at least one level will indicate clinical importance. Safety is evaluated by identifying adverse events and comparing their occurrence to surgical repair of CoA in similar age groups reported in the medical literature.

Eligibility criteria: Inclusion Criteria: Inclusion criteria for use of a Covered CP Stent:

Native or recurrent aortic coarctation\* associated with ONE OR MORE of the following:

1. Acute or chronic aortic wall injury, or
2. Nearly atretic descending aorta to 3 mm or less in diameter, or
3. Genetic Syndromes associated with aortic wall weakening. Individuals with genetic syndromes such as Marfan Syndrome, Turner's Syndrome or familial bicuspid aortic valve and ascending aortic aneurysm

   * The significance of aortic obstruction is left to the judgment of the participating investigator.

indications might include mild resting aortic obstruction associated with:

* Exercise related upper extremity hypertension;
* Severe coarctation with multiple and/or large arterial collaterals;
* Single ventricle physiology
* Left ventricular dysfunction
* Ascending aortic aneurysm

  + Aortic wall injury might include:
* Descending aortic aneurysm
* Descending aortic pseudo-aneurysm
* Contained aortic wall rupture
* Non-contained rupture of the aortic wall

Exclusion Criteria:

1. Patient size too small for safe delivery of the device. The absolute lower limit for inclusion under this protocol is 20 kg. However, serious femoral artery injury can occur in small patients, particularly those in the 20-30 kg range and this risk must be reviewed in detail with parents or guardians of children in this weight range.
2. Planned deployment diameter less than 10 mm or greater than 22 mm
3. Location requiring covered stent placement across a carotid artery\*
4. Adults lacking capacity to consent
5. Pregnancy

   * crossing or covering of a subclavian artery is acceptable in certain situations, but only after alternative treatments have been considered.

Primary outcomes:
measure: Study Participants With Grade 4 or 5 in Degree of Aortic Wall Injury (AWI) and/or Aortic Arch Obstruction Without Clinical Worsening
timeFrame: Baseline and 12 months
Secondary outcomes:
measure: Secondary Efficacy Outcomes - 1 Year
timeFrame: 1 years
measure: Secondary Safety Outcomes - Adverse Events
timeFrame: 2 years
Other outcomes:
Locations:
city: San Diego
country: United States
facility: Rady Children's Hospital and Health Center
state: California
city: San Francisco
country: United States
facility: University of California, San Francisco
state: California
city: Washington
country: United States
facility: Children's National Medical Center
state: District of Columbia
city: Miami
country: United States
facility: Miami Children's Hospital
state: Florida
city: Atlanta
country: United States
facility: Children's Healthcare of Atlanta
state: Georgia
city: Baltimore
country: United States
facility: Johns Hopkins Hospital
state: Maryland
city: Boston
country: United States
facility: Boston Children's Hospital
state: Massachusetts
city: Detroit
country: United States
facility: Children's Hospital of Michigan
state: Michigan
city: Rochester
country: United States
facility: Mayo Clinic
state: Minnesota
city: New York
country: United States
facility: Children's Hospital of New York - Presbyterian
state: New York
city: Durham
country: United States
facility: Duke University
state: North Carolina
city: Cincinnati
country: United States
facility: Cincinnati Children's Hospital and Medical Center
state: Ohio
city: Cleveland
country: United States
facility: Cleveland Clinic Foundation
state: Ohio
city: Columbus
country: United States
facility: Nationwide Children's Hospital
state: Ohio
city: Philadelphia
country: United States
facility: Children's Hospital of Philadelphia
state: Pennsylvania
city: Pittsburgh
country: United States
facility: Children's Hospital of Pittsburgh of UPMC
state: Pennsylvania
city: Dallas
country: United States
facility: Children's Medical Center Dallas
state: Texas
city: Houston
country: United States
facility: Baylor College of Medicine, Texas Children's Hospital
state: Texas
city: Seattle
country: United States
facility: Children's Hospital and Regional Medical Center, Seattle
state: Washington
Study officials:
affiliation: Rady Children's Hospital
name: John Moore, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: Nicklaus Children's Hospital f/k/a Miami Children's Hospital
name: John F Rhodes, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: Seattle Children's Hospital
name: Thomas Jones, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: Boston Children's Hospital
name: Lisa Bergersen, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: Morgan Stanley Children's Hospital
name: Julie A Vincent, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: Mayo Clinic
name: Allison Cabalka, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: Baylor College of Medecine, Texas Children's Hospital
name: Henri Justino, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: Children's Hospital of Michigan
name: Thomas Forbes, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: Children's Hospital of Philadelphia
name: Jonathan Rome, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: Children's National Research Institute
name: Joshua Kanter, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: University of California, San Francisco
name: Phil Moore, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: Children's Hospital Medical Center, Cincinnati
name: Russel Hirsch, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: University of Pittsburgh
name: Jacqueline Kreutzer, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: Children's Medical Center Dallas
name: Thomas Zellers, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: The Cleveland Clinic
name: Lourdes Prieto, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: Duke University
name: Gregory Fleming, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: Children's Healthcare of Atlanta
name: Dennis Kim, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: Nationwide Children's Hospital
name: John Cheatham, MD
role: PRINCIPAL_INVESTIGATOR
affiliation: Duke University
name: Gregory A Fleming, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Holzer RJ, Gauvreau K, McEnaney K, Watanabe H, Ringel R. Long-Term Outcomes of the Coarctation of the Aorta Stent Trials. Circ Cardiovasc Interv. 2021 Jun;14(6):e010308. doi: 10.1161/CIRCINTERVENTIONS.120.010308. Epub 2021 May 27.