Overview
This study aims to evaluate the safety and effectiveness of the CorVad Percutaneous Ventricular Assist System for short-term ventricular support during high-risk percutaneous coronary intervention (HRPCI) in non-emergent, hemodynamically stable coronary artery disease patients via a prospective, multicenter, single-arm clinical trial.
Description
This prospective, multicentre, single-arm clinical trial of the CorVad Percutaneous Ventricular Assist System is designed to measure the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) at 30 days after PCI and is planned to enrol 120 subjects.
The target population of subjects are patients with coronary artery disease who need high-risk PCI treatment, and sign an informed consent form (ICF) approved by the Ethics Committee (EC). Subjects who meet the enrolment criteria as judged by the investigator will apply the trial product according to the requirements and will be followed up to 30 days after the procedure.
Eligibility
Inclusion Criteria:
- 1. 18 years old≤ patient age ≤90 years old;
- 2. Patient willing and able to comply with protocol requirements and data collection procedures; able to understand study purpose and sign informed consent;
- 3. As assessed by the cardiac team the patient needs coronary revascularization, but CABG (Coronary Artery Bypass Grafting) is of high risk, or the patient refuses to undergo CABG. After comprehensive evaluation, the cardiac team believes that the patient can benefit from PCI (Percutaneous Coronary Intervention);
- 4. The patient is hemodynamically stable and meeting one of the following:
- Left ventricular ejection fraction (LVEF) ≤30%, with multivessel disease, planning PCI to at least one complex lesion* in a major epicardial vessel or branch;
- LVEF ≤35% and either:
- Unprotected left main intervention;
II. Or last patent coronary conduit;
- LVEF ≤40%, planning PCI to at least one complex lesion* in a major epicardial
vessel or branch. The intervention team confirms there is a risk of cardiac
arrest or circulatory collapse. This must be confirmed by at least two associate
senior physicians or one chief senior physician.
- Complex lesions include moderate-to-severe calcification, chronic total occlusions (CTO), diffuse disease, bifurcation lesions, severe tortuosity, etc.
Exclusion Criteria:
- 1. ST-segment elevation myocardial infarction (STEMI) on ECG within 7 days;
- 2. Cardiac arrest requiring cardiopulmonary resuscitation within 24 hours pre-procedure;
- 3. Cardiogenic shock defined as meeting all of the following:
- Systolic blood pressure <90mmHg, or requiring vasopressors/inotropes to maintain blood pressure >90mmHg;
- Clinical evidence of end-organ hypoperfusion (cold extremities or urine output <30ml/h), or use of IABP or other mechanical circulatory assist device;
- Cardiac index (CI) <2.2L/min/m^2 and pulmonary capillary wedge pressure (PCWP) >15mmHg;
- 4. Presence of left ventricular thrombus;
- 5. Presence of mechanical aortic valve or cardiac contractility device;
- 6. Presence of moderate-to-severe aortic valve stenosis;
- 7. Presence of moderate-to-severe aortic valve insufficiency;
- 8. Deemed unable to tolerate percutaneous ventricular assist device based on clinical or imaging assessment, including iliac/femoral artery diameter <6mm, severe tortuosity, severe bilateral iliofemoral/femoral artery disease, or other peripheral vascular disease;
- 9. Presence of aortic vascular disease or aortic dissection;
- 10. Presence of uncorrected, sustained ventricular arrhythmia causing inability to stable position percutaneous ventricular assist device;
- 11. History of stroke with permanent neurological deficit, intracerebral hemorrhage, subdural hematoma, or conditions predisposing to intracranial hemorrhage such as arteriovenous malformation or mass;
- 12. End-stage renal disease requiring dialysis or serum creatinine ≥4mg/dL;
- 13. Presence of potential bleeding diathesis or hypercoagulable state;
- 14. Pregnancy (for women of childbearing potential, pregnancy test required within 7 days prior to PCI procedure);
- 15. Presence of contraindication to anticoagulation;
- 16. History of liver failure, with ALT, AST, and bilirubin elevated to 3 times the upper limit of normal (ULN) or international normalized ratio (INR) ≥2;
- 17. Presence of uncorrected abnormal coagulation parameters (platelet count ≤75,000/mm^3, INR≥2.0, or fibrinogen ≤1.50g/L);
- 18. Presence of uncontrolled active infection requiring antibiotic therapy;
- 19. Participation in any other clinical trial that may impact the results of this study;
- 20. Other circumstances that are unforeseen and determined by the investigator to be unsuitable for the study.