The Asahi Intecc PTCA Chronic Total Occlusion Study

This prospective, multi-center, single-arm, intent-to-treat (ITT) study is designed to assess the safety and effectiveness of the investigational products for the treatment of CTOs in a native coronary artery.

The primary objective of this trial is to evaluate confirmation of placement of any guidewire beyond the CTO in the true vessel lumen in patients in which at least one Asahi series of guidewires and/or Corsair microcatheter were used.

The population for this study is subjects with signs and/or symptoms considered typical of ischemic heart disease attributed to a CTO in a native coronary artery, who are suitable for a percutaneous revascularization.

Procedure success will be defined as angiographic visualization of any guidewire in a position either distal or proximal to the occlusion depending on the route of access and the absence of in-hospital major adverse cardiac events (MACE). All subjects are followed through hospital discharge.

Inclusion criteria

• General Inclusion Criteria:

• Subject is ≥ 18 years of age at the time of consent
• Subject is experiencing clinical symptoms considered suggestive of ischemic heart disease (e.g., chest pain or discomfort, heart failure, etc.) or has evidence of myocardial ischemia (e.g., abnormal functional study) attributed to the CTO target vessel and is scheduled for clinically indicated percutaneous revascularization
• Subject is eligible and consents to undergo PCI procedure
• Subject is an acceptable candidate for percutaneous transluminal coronary angioplasty (PTCA), stenting, and emergency coronary artery bypass grafting (CABG)
• Subject is willing and able to sign an Informed Consent Form approved by a local Institutional Review Board
• Female subjects of child-bearing potential must have a negative qualitative or quantitative pregnancy test within 7 days before the study procedure

Angiographic Inclusion Criteria:

• A minimum of one de novo lesion with at least one target segment in a native coronary vessel meeting definition of chronic total occlusion. Non-study lesions will be treated first. A "chronic total occlusion" is any non-acute total coronary occlusion fulfilling the angiographic characteristics consistent with high-grade native coronary stenosis (TIMI 0) and estimated in duration at least 3 months by clinical history and/or comparison with antecedent angiogram or electrocardiogram. An attempt to cross the target lesion with at least one Asahi guidewire or a Corsair microcatheter must be made.

Exclusion criteria

• General Exclusion Criteria:

• Subjects with any history of allergy to iodinated contrast that cannot be effectively managed medically
• Evidence of acute Myocardial Infarction (MI) within 72 hours of the intended treatment defined as cardiac enzymes greater than Upper Limit of Normal (ULN).
• Previous coronary interventional procedure of any kind within the 30 days prior to the procedure
• Any contraindication to cardiac catheterization or to any of the standard concomitant therapies used during routine cardiac catheterization and PCI (e.g., aspirin, clopidogrel, unfractionated heparin, etc.)
• Target lesion requires treatment with a device after successful crossing other than PTCA prior to stent placement
• Subjects with known history of clinically significant abnormal laboratory findings including:

• Neutropenia (<1000 neutrophils/mm3) within the previous 2 weeks
• Thrombocytopenia (<100,000 platelets/mm3)
• AST, ALT, alkaline phosphatase, or bilirubin > 1.5 × ULN
• Serum creatinine > 2.0 mg/dL
• Subjects with evidence of ongoing or active clinical instability including the following:

• Sustained systolic blood pressure < 100 mmHg or cardiogenic shock
• Acute pulmonary edema or severe congestive heart failure
• Suspected acute myocarditis, pericarditis, endocarditis, or cardiac tamponade
• Suspected dissecting aortic aneurysm
• Hemodynamically significant valvular heart disease, hypertrophic cardiomyopathy, restrictive cardiomyopathy, or congenital heart disease
• History of stroke or transient ischemic attack within the prior 6 months
• Active peptic ulcer or upper gastrointestinal (GI) bleeding within the prior 6 months
• History of bleeding diathesis or coagulopathy or refusal of blood transfusions
• Subjects with any other pathology such as cancer, mental illness, etc., which in the opinion of the Investigator, might put the patient at risk, preclude follow-up, or in any way confound the results of the study
• Known previous medical condition yielding expected survival less than 1 year
• Subjects who are unable or unwilling to comply with the protocol or not expected to complete the study period, including its follow-up requirements
• Currently participating in an investigational drug or another device study that has not completed the primary endpoint or that clinically interferes with the current study endpoints;

Angiographic Exclusion Criteria:

• Occlusion involves segment within previous stent
• Extensive lesion-related thrombus (TIMI thrombus grade 3 or 4)
• Previous stenting (drug-eluting or bare metal) in the target vessel unless the following conditions are met:

• It has been at least 9 months since the previous stenting
• That target lesion is at least 15 mm away from the previously placed stent
• The previously stented segment (stent plus 5 mm on either side) has no more than 40% diameter stenosis, based on visual estimate
• The target vessel has other lesions proximal to the total occlusion identified with greater than 75% diameter stenosis based on visual estimate. However, planned stenting of the lesion in target vessel which is proximal to the target lesion and can be covered by a single stent (i.e., tandem lesions) are acceptable.