OCT-Guided Coronary Bypass Grafting for Graft Failure

(OCTOCAB Trial)

Recruiting in Palo Alto (17 mi)

Overseen by Edward F. Lundy, MD, PhD

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Recruiting

Sponsor: St. Francis Hospital, New York

Must not be taking: Aspirin, P2Y12 inhibitors

Disqualifiers: STEMI, CHF, LVEF <30%, others

No Placebo Group

Approved in 2 Jurisdictions

Trial Summary

What is the purpose of this trial?

This trial is testing whether using a special imaging technique during heart surgery can reduce early complications. It targets patients undergoing heart surgery, as their veins often have issues soon after the procedure. The imaging technique helps doctors find hidden problems.

Will I have to stop taking my current medications?

The trial protocol does not specify whether you need to stop taking your current medications. However, if you have a known allergy or cannot take any of the study drugs like aspirin or P2Y12 inhibitors, you may not be eligible to participate.

What data supports the effectiveness of the treatment OCT-guided saphenous vein CABG?

Optical coherence tomography (OCT) helps in identifying and analyzing atherosclerotic lesions (buildup of fats, cholesterol, and other substances in and on the artery walls) in saphenous vein grafts, which can guide successful stent placement and potentially improve outcomes in coronary bypass surgeries. ^{1 2 3 4 5}

Is OCT-guided coronary bypass grafting generally safe for humans?

The research does not provide specific safety data for OCT-guided coronary bypass grafting, but it does mention that optical coherence tomography (OCT) can help identify issues in saphenous vein grafts, which are commonly used in coronary bypass surgery. While the studies focus on identifying problems and treatment strategies, they do not directly address the safety of OCT-guided procedures. ^{1 2 6 7 8}

What makes OCT-guided SV CABG unique compared to other treatments for graft failure?

OCT-guided SV CABG is unique because it uses optical coherence tomography (OCT) to provide detailed images of the inside of blood vessels, allowing doctors to precisely identify and treat problematic areas in saphenous vein grafts, which can improve the success of the surgery and reduce complications. ^{1 2 3 7 9}

Research Team

Ziad A. Ali, MD, DPhil

Principal Investigator

Saint Francis Hospital

Edward F. Lundy, MD, PhD

Principal Investigator

Saint Francis Hospital

Eligibility Criteria

This trial is for adults with myocardial ischemia suitable for elective coronary artery bypass grafting (CABG) who can consent to the study. Excluded are those with severe heart failure, recent STEMI, significant kidney dysfunction, unstable arrhythmias, prior CABG, extreme platelet counts, liver disease, short life expectancy due to non-cardiac causes or conditions that could affect participation or results.

Inclusion Criteria

Subject must provide written Informed Consent prior to any study related procedure

I have heart issues that may require bypass surgery.

I am 18 years old or older.

Exclusion Criteria

I am undergoing or have undergone surgery on multiple heart valves or the main artery coming from my heart.

I have had coronary artery bypass surgery.

Life expectancy <2 years for any non-cardiac cause

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo coronary artery bypass graft surgery with either OCT-guided or visual inspection-guided saphenous vein grafting

Surgery duration

1 visit (in-person)

Follow-up

Participants are monitored for vein graft failure and other outcomes using coronary CT angiogram and other assessments

12 months

Regular follow-up visits as needed

Long-term follow-up

Participants are followed for up to 10 years to assess long-term outcomes and vein graft patency

Up to 10 years

Treatment Details

Interventions

• OCT-guided saphenous vein CABG (Imaging Device)

Trial Overview The OCTOCAB trial tests if using intravascular optical coherence tomography (OCT) during saphenous vein grafting in CABG surgery can lower early vein graft failure rates. It's a prospective study where participants are randomly assigned to receive either the standard procedure or the OCT-guided technique.

Participant Groups

Group I: OCT-guided saphenous vein graft coronary artery bypass graft surgery Experimental Treatment 1 Intervention

Optical Coherence Tomography (OCT) provides high quality intravascular images by using infrared light. OCT will assess the harvested saphenous vein conduit in Coronary Bypass Graft Surgery (CABG). Abnormalities found in the harvested conduits via OCT, at the discretion of the surgeon, will not be utilized for CABG.

Group II: Visual inspection-guided saphenous vein graft coronary artery graft surgery Active Control 1 Intervention

Harvested saphenous vein conduits will be assessed visually and will undergo a blinded OCT.

Who Is Running the Clinical Trial?

St. Francis Hospital, New York

Lead Sponsor

Trials

9

Recruited

2,300+

Findings from Research

Optical coherence tomography (OCT) provides a detailed analysis of atherosclerosis in saphenous vein grafts, revealing lesions that may not be apparent through angiography alone.

In a case study of a 67-year-old diabetic male, OCT successfully identified the culprit lesion in a graft, leading to effective stent placement and treatment of acute coronary syndrome.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Findings of optical coherence tomography in saphenous grafts failure. Report of one case]. Pérez, L., Venegas, R., Ibieta, G., et al.[2022]

Optical coherence tomography (OCT) revealed that atherosclerotic lesions in saphenous vein grafts (SVGs) of patients with acute coronary syndromes (ACS) are predominantly fibrofatty, with significant occurrences of plaque rupture (60.7%) and thrombus (46.4%), indicating complex lesion characteristics.

The study, which included 28 SVGs from 26 patients, found that the presence of thrombus increased with the severity of ACS, suggesting that similar pathological mechanisms may be at play in SVGs as in native coronary arteries.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluation of culprit saphenous vein graft lesions with optical coherence tomography in patients with acute coronary syndromes. Davlouros, P., Damelou, A., Karantalis, V., et al.[2022]

Sequential saphenous vein grafts (SVGs) show significantly higher long-term patency rates (82%) compared to individual SVGs (68%) in coronary bypass procedures, based on an analysis of 875 anastomoses in 430 patients over an average of 5.8 years.

The benefits of sequential grafts are especially notable in cases with poor-quality coronary arteries, where the patency rate for sequential grafts is 57% compared to just 28% for individual grafts, highlighting the importance of grafting techniques and vessel characteristics.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Long-term patency of sequential and individual saphenous vein coronary bypass grafts. Vural, KM., Sener, E., Taşdemir, O.[2019]

Saphenous vein grafts (SVGs) are commonly used in coronary artery bypass grafting (CABG), but their long-term success is limited by significant rates of vein graft failure (VGF).

The choice of storage solution for SVGs affects their structure and function, yet there is currently no clear evidence supporting the superiority of any specific solution, highlighting the need for further research to guide clinical practices.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Storage solutions to improve grafts preservation and longevity in coronary artery bypass grafting surgery: hype or hope? Eqbal, A., Gupta, S., Bisleri, G.[2023]

In a study of 24 patients who underwent coronary artery bypass graft surgery, external stenting of saphenous vein grafts (SVGs) resulted in a more uniform and circular lumen compared to unstented grafts, which may help reduce the risk of graft failure.

No thrombus formation was observed in the stented grafts, while adherent thrombus was found in three unstented grafts, suggesting that external stenting may enhance the safety and efficacy of SVGs post-surgery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

OCT imaging of aorto-coronary vein graft pathology modified by external stenting: 1-year post-surgery. Webb, CM., Orion, E., Taggart, DP., et al.[2017]

In a study of 75 patients with 133 saphenous venous grafts (SVGs) followed for an average of 67.6 months after coronary artery bypass grafting (CABG), elevated plasma homocysteine (Hcy) levels were significantly associated with SVG degeneration, particularly in narrowed grafts.

The research found that for every 1 µmol/L increase in Hcy, there was a corresponding 0.053% per month decrease in graft lumen diameter, suggesting that higher Hcy levels can lead to significant long-term reductions in graft patency.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Plasma homocysteine levels are related to medium-term venous graft degeneration in coronary artery bypass graft patients. Balogh, E., Maros, T., Daragó, A., et al.[2018]

Saphenous vein grafts (SVG) are commonly used in coronary bypass surgery but face significant long-term issues, with nearly 50% developing serious narrowing and 40% becoming completely blocked within ten years.

Current treatment options for SVG failure, such as redo-surgery and percutaneous interventions, come with risks like complications and reduced graft success, highlighting the need for improved strategies to maintain graft patency and enhance patient outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Saphenous vein graft disease: causes, prevention, and contemporary treatment strategies]. Gökay, S., Ciçek, D.[2018]

In a study of 49,325 older patients (median age 75) with failing saphenous vein grafts, those treated with drug-eluting stents (DES) had a significantly lower 3-year mortality rate (22.7%) compared to those treated with bare metal stents (BMS) (28.0%).

There was no significant difference in the rates of myocardial infarction or urgent revascularization between DES and BMS patients, indicating that DES may be a safer option without compromising other important clinical outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Safety and clinical effectiveness of drug-eluting stents for saphenous vein graft intervention in older individuals: Results from the medicare-linked National Cardiovascular Data Registry(®) CathPCI Registry(®) (2005-2009). Brennan, JM., Sketch, MH., Dai, D., et al.[2017]

References

1. Chile pubmed.ncbi.nlm.nih.gov

[Findings of optical coherence tomography in saphenous grafts failure. Report of one case]. [2022]

2. United States pubmed.ncbi.nlm.nih.gov

Evaluation of culprit saphenous vein graft lesions with optical coherence tomography in patients with acute coronary syndromes. [2022]

3. Germany pubmed.ncbi.nlm.nih.gov

Long-term patency of sequential and individual saphenous vein coronary bypass grafts. [2019]

4. United States pubmed.ncbi.nlm.nih.gov

Storage solutions to improve grafts preservation and longevity in coronary artery bypass grafting surgery: hype or hope? [2023]

5. England pubmed.ncbi.nlm.nih.gov

OCT imaging of aorto-coronary vein graft pathology modified by external stenting: 1-year post-surgery. [2017]

6. Turkey pubmed.ncbi.nlm.nih.gov

Plasma homocysteine levels are related to medium-term venous graft degeneration in coronary artery bypass graft patients. [2018]

7. Turkey pubmed.ncbi.nlm.nih.gov

[Saphenous vein graft disease: causes, prevention, and contemporary treatment strategies]. [2018]

8. United States pubmed.ncbi.nlm.nih.gov

Safety and clinical effectiveness of drug-eluting stents for saphenous vein graft intervention in older individuals: Results from the medicare-linked National Cardiovascular Data Registry(®) CathPCI Registry(®) (2005-2009). [2017]

9. Netherlands pubmed.ncbi.nlm.nih.gov

Value of saphenous vein graft markers during subsequent diagnostic cardiac catheterization. [2022]