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NCT Number: NCT07022587

Bioresorbable Sirolimus-eluting scaffold in de Novo Coronary Artery Lesions

Bioresorbable scaffold (BRS) was designed aiming to avoid the late adverse events associated with permanent metallic stents by providing temporary support to the vessel wall and promoting vessel remodeling, plaque reduction, and restoring vasomotion after its full absorption. As the first FDA-approved BRS, ABSORB BRS was associated with a significantly higher risk of late scaffold thrombosis compared with everolimus-eluting stent (EES). As a result, the ESC-EAPCI task force recommended that the current ABSORB BRS should not be preferred over conventional DES in clinical practice. To solve this dilemma, improved scaffold technology and optimal implantation techniques are necessary.

The latest generation Firesorb BRS is a PLLA backbone scaffold system abluminally coated with poly(D, L-lactide) mixed with sirolimus using highly accurate and precise point spraying techniques. Compared to the ABSORB BRS, Firesorb features a thinner stent thickness (100-125 μm) while maintaining sufficient radial support, enabling faster degradation and a shorter duration of presence in the coronary. Additionally, inspired by the design of the Firehawk DES, its unique spot-coating process applies a single-sided coating layer exclusively to the stent's outer surface, enabling targeted drug release. Preclinical trials have demonstrated favorable performance for Firesorb, culminating in its approval by the National Medical Products Administration (NMPA) in 2024.

Against these backgrounds, we have designed this trial to investigate whether the Firesorb BRS is non-inferior to the drug-eluting stent in terms of the Device-Oriented Composite Endpoint (DoCE) in patients undergoing percutaneous coronary intervention for de novo lesions.

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Key information

Age range

18 year–75 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Xijing Hospital

Xi'an, Shannxi, 710032, China

Location status: Recruiting

Location contact

Chao Gao

CONTACT

[email protected]

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

Clinical inclusion criteria

  • Patients with an indication for PCI due to acute or chronic coronary syndrome
  • Patients who understand the study's objectives, voluntarily participate, sign the informed consent form, and are willing to undergo regular follow-up

Angiographic inclusion criteria

  • De novo lesion(s)
  • Target vessel diameter of ≥ 2.5 mm to ≤ 4.00 mm, target lesion length ≤ 25 mm (visual estimation)
  • Target lesion is NOT
  • Severely calcified
  • In-stent restenosis
  • Diffused lesion requiring stent overlapping or more than one stent
  • Located in the left main, aorto-ostial, proximal LAD/LCX/RCA involving vessel ostia (stent coverage required within 3 mm of vessel ostia), surgical graft, myocardial bridge, or chronic total occlusion
  • Bifurcation requiring two stents or involving a side branch that is ≥ 2.5 mm in diameter
  • Located in the target vessel with severe tortuosity

Exclusion criteria

  • Age < 18 years, or > 75 years
  • Patient is a woman who is pregnant or nursing
  • Patients who have received any stent implantation in the target vessel within one year
  • Patients required long-term oral anticoagulation
  • Known non-adherence to antiplatelet therapy or not suitable for long-term antiplatelet therapy due to high bleeding risk
  • Patients who are allergic to heparin, poly L-lactic acid (PLLA), sirolimus, antiplatelet drugs, or contrast
  • Currently participating in another trial and not yet at its primary endpoint
  • Patients whose life expectancy is less than 3 years
  • Cardiogenic shock

Treatment and study plan

Sirolimus-eluting bioresorbable scaffolds

Device

The Firesorb BRS (MicroPort Medical, Shanghai, China) is a balloon-expandable scaffold with a highly crystallized PLLA backbone, abluminally coated with a poly(D, L-lactide) (PDLLA) matrix incorporating sirolimus (4 μg/mm) through highly accurate and precise point spraying techniques. The scaffold thickness is 100 μm for devices with diameters of 2.5 and 2.75 mm, and 125 μm for those ranging from 3.0 to 4.0 mm in diameter. There are two radiopaque markers at each end of the scaffold, which can identify the position of the stent under X-ray monitoring and help to accurately locate the scaffold.

Sirolimus-eluting stents

Device

The Firehawk™ stent (MicroPort Medical, Shanghai, China) is a third-generation balloon-expandable L605 cobalt chromium stent with abluminal grooves containing a biodegradable polymer, which provides controlled release of the anti-proliferative medicinal substance sirolimus. The polymer is biodegradable, leaving only the metallic stent as a permanent implant. The stent is mounted on a rapid exchange delivery catheter system. The unique abluminal grooves are scored at the outer surface of the struts (total strut thickness: 86 μm), with an average sirolimus dosage of 3 µg/mm stent lengths.

Primary outcomes

  1. Cumulative event rate of Device-oriented Composite Endpoint (DoCE)

    Time frame: 36 months

    DoCE is a composite clinical endpoint of cardiovascular death, target vessel myocardial infarction (TV-MI), and clinically and physiologically indicated target lesion revascularization (CPI-TLR).

Secondary outcomes

  1. Cumulative event rate of Device-oriented Composite Endpoint (DoCE)

    Time frame: 1, 12, and 60 months

    Rates of the DoCE beside the time point of primary endpoint

  2. Cumulative event rate of Patient-oriented composite endpoint (PoCE)

    Time frame: 1, 12, 36, and 60 months

    PoCE is defined as a composite endpoint including all-cause death, stroke, myocardial infarction, and revascularization

  3. Cumulative event rate of Target vessel failure (TVF)

    Time frame: 1, 12, 36, and 60 months

    TVF is defined as a composite endpoint including cardiovascular death, TV-MI and clinically and physiologically target vessel revascularization

  4. Cumulative event rate of All-cause death

    Time frame: 1, 12, 36, and 60 months

    Individual components of PoCE

  5. Cumulative event rate of Cardiovascular death

    Time frame: 1, 12, 36, and 60 months

    Individual components of the DoCE

  6. Cumulative event rate of Stroke

    Time frame: 1, 12, 36, and 60 months

    Individual components of PoCE

  7. Cumulative event rate of Myocardial infarction

    Time frame: 1, 12, 36, and 60 months

    Individual components of PoCE

  8. Cumulative event rate of Target vessel myocardial infarction (TV-MI)

    Time frame: 1, 12, 36, and 60 months

    Individual components of DoCE

  9. Cumulative event rate of Revascularization

    Time frame: 1, 12, 36, and 60 months

    Individual components of PoCE

  10. Cumulative event rate of Clinically and physiologically indicated target vessel revascularization

    Time frame: 1, 12, 36, and 60 months

    Individual components of TVF

  11. Cumulative event rate of Clinically and physiologically indicated target lesion revascularization (CPI-TLR)

    Time frame: 1, 12, 36, and 60 months

    Individual components of the DoCE

  12. Cumulative event rate of Definite/Probable scaffold/stent thrombosis

    Time frame: 1, 12, 36, and 60 months

    According to ARC-2 definitions

  13. Cumulative event rate of BARC defined type 3 or 5 bleeding events

    Time frame: 1, 12, 36, and 60 months

Study contacts

Contact information is provided by the study sponsor or research team.

Chao Gao, M.D., Ph.D.

CONTACT

[email protected]

+86-18629551066

Ruining Zhang, BSc

CONTACT

[email protected]

+86-15802990370

Sponsors and collaborators

Lead sponsor

Xijing Hospital

Other

Registry information

Official study title

A Bioresorbable Sirolimus-eluting scaffold Versus a Metallic Sirolimus-eluting Stent for the Treatment of de Novo Coronary Artery Lesions: a Randomized, Open-label, Non-inferiority Trial

Acronym: REC-CAGEFREE Ⅳ

Important dates

Study start
2025
Primary completion
2030
Study completion
2073
First posted
Jun 15, 2025
Registry last updated
Feb 13, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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