Jens  Flensted  Lassen  MD,  PH.D.,  FESC.Clinical Director,  Associated  professor  Cardiac Catheterization Laboratory

Department  of  Cardiology,  The  Heart  Centre,  Rigshospitalet,  University of  Copenhagen  

Copenhagen,  Denmark

Breakfast  Meeting:  Establising the  New  Standard:  Definitive  Treatment  for  Complex  Bifurcation  Lesions.

(Sponsered by  Tryton medical,  Inc.).

TCT2016,  October  30.  2016,  Washington  DC.  USA

Importance  of  Side  Branch  Ostial  Scaffolding

Disclosure  Statement  of  Financial  Interest

I,  (Jens  Flensted  Lassen)  DO  NOT  have  a  financial  interest/arrangement  or  affiliation  with  one  or  more  organizations  that  could  be  perceived  as  a  real  or  apparent  conflict  of  interest  in  the  context  of  the  subject  of  this  presentation.

Disclosure  Statement  of  Financial  Interest

…….  BUT  !!!I,  (Jens  Flensted  Lassen)  am  a  Board  member  and  one  of  the  Directors  of  the  European  Bifurcation  Club  (EBC)  and  my  view  on  bifurcation  stenting  is  heavily  influenced  by  the  thoughts  and  consensus  statements  of  EBC.

STRESS-­trial  (1994)  and  Benestent (1994)≈  Tryton  Pivotal  (2015)  

Instent restenose

Norstent Trial  (n=9013)

• Workhorse  DES:  Optimized  for  Straight  LesionsPoorly  Suited  to  of  Bifurcation  Lesions

• Wide  Variety  of  Techniques  RequiredPoorly  Characterized  Inconsistently  Performed:

Crush,  Culotte,  reverse  Culotte,  internal  crush,  reverse  crush,  T,  provisional  T,  TAP,  TAP  and  protusion,  Y,  extended  Y,  V,  SKS,  double  barrel,  Helqvist,  sleeve,  modified  crush,  Buchbinder,  mini  crush,  reverse  mini  crush,  short  back  and  sides,  DK  crush,  flower,  etc.,  etc.

Treating  Bifurcation  LesionsWhy  is  it  difficult  to  evaluate?

Crush  Technique

Courtesy  of  J.  Ormiston

Not  all  2  stent  techniques  are  the  sameStents  not  designed  for  bifurcation

Triple  layerLimited  scaffolding

Nordic  II:  Localization  of  In-­Stent  Restenosis  at  8-­Month  Follow-­up

Angiographic restenosis*  at  8  months

Nordic-­Baltic  Bifurcation  Study  IV

Binary restenosis ≥  50%  diameter  stenosisQCA  by  dedicated bifurcation analysis.  Medis QAngioXA 7.3

1.3% 0.7%

1.3%1.3%

n  =  153 n  =  154

Provisional SB  stent technique Two-­stent  technique (Culotte/T)

niels.holm@clin.au.dk

5.2%  20.3%

What  is  the  ideal  technique  or  the  ideal  device  for  coronary  bifurcation  treatment  and  does  one  strategy  or  device  fit  all?  

Tryton  StentDesigned  for  all  coronary  bifurcations

Ostial  Scaffolding >3.5  mm>4.5  mmExpansion  range

No  Angle  Limitations

Summary  &  Conclusion• Tryton  stent  was  designed  to  accommodate  variations  in  vessel  caliber  and  angle  while  providing  main  vessel  stent-­like  scaffolding  to  the  ostium  and  side  branch.

• The  in  vitro  results  have  been  confirmed  in  daily  clinical  practice.

• One  technique  may  fit  all  bifurcations  – if  the  side  branch  is  large  enough.