LEADERS FREE IV (RCT): BioFreedom™ Ultra vs BioFreedom™ in HBR Patients

Prior treatment

• Severe calcification that might prevent sufficient expansion of the DES, unless pre-treated with a plaque modification device such as cutting balloon, scoring balloon or intravascular lithotripsy.
  • Note: Use of rotational or orbital atherectomy is also permitted.
• Any PCI during the previous 12 months

Other illness

• Patients lacking capacity (i.e. patients suffering from dementia and others) to provide informed consent
• Active bleeding at the time of inclusion
• Known hypersensitivity or contraindication to aspirin, clopidogrel (or to any other P2Y12 inhibitor if applicable), cobalt chromium, stainless steel, zinc, Biolimus A9™ or a sensitivity to contrast media, which cannot be adequately pre-medicated

Lab values

• Patient has known left ventricular ejection fraction (LVEF) \<30% (LVEF may be obtained at the time of the index procedure if the value is unknown and the investigator believes it is necessary)
• Compliance with long-term single anti-platelet therapy unlikely

Age

• Age \<18 years old

Other

• Pregnant and breastfeeding women
• Patients expected not to comply with 1 month DAPT
• Procedure requires the use of non-study stents, or alternative therapeutic options not followed by stent implantation (angioplasty only, atherectomy only)
• Number of target lesions \>2
• Patient requires a stent of diameter \<2.25mm
• Patient requires a stent of diameter \>4.0mm
• Isolated ostial lesions within 3 mm of the origin of LAD or LCx (left main lesions involving the ostia of the LAD and/or LCx are eligible)
• Patient with chronic total occlusion(s) as target lesion(s)
• Cardiogenic shock
• Participation in another clinical study (12 months after index procedure)
• Patients with a life expectancy of \<12 months

• Patients at high bleeding risk (HBR) with an indication for PCI who can tolerate at least one month of DAPT. This includes patients with stable angina, silent ischemia, acute coronary syndromes (ACS) (STEMI and NSTEMI), de novo lesions in native arteries with diameter stenosis \>70% by visual estimation and evidence of ischemia in the territory of the target vessel(s).
• Patients meet ARC-HBR definition i.e at least 1 major or 2 minor criteria.