Assessment with optical coherence tomography of a new strategy for bifurcational lesion treatment: The Tryton Side‐Branch Stent

Abstract

The Tryton-Side Branch Stent (Tryton Medical, Inc., Newton, MA, USA) is a dedicated stent designed to provide complete carinal coverage of bifurcational lesions. After implantation of a 18 mm cobalt chromium Tryton stent from the left circumflex into the obtuse marginal branch, recrossing with an everolimus eluting Promus stent and final kissing balloon dilatation, optical coherence tomography (OCT) (LightLab Imaging Inc., Westford, MA, USA) was performed with a non-occlusive technique with motorized pullback (3 mm/s) during continuous pump injection of iso-osmolar contrast, in both LCx and OM1. OCT imaging showed good strut apposition at the level of the carina, with full coverage and no stent protrusion at the ostium of the side branch. Few malapposed struts were present in the proximal main vessel in the segment of stent superimposition, with a maximal separation from to the vessel wall of 160 microm. The implantation of the Tryton-Side Branch Stent allowed full coverage of the side branch ostium with uniform apposition of the stent struts at the level of the carina assessed by OCT.

Avaliação ultrassonográfica intracoronária de imagem angiográfica duvidosa durante intervenção percutânea em bifurcação

“…3,9 New imaging techniques with higher resolution than IVUS are available for atherosclerotic bifurcation disease assessment, such as optical coherence tomography, which could offer greater diagnostic precision of incomplete apposition and late stent thrombosis risk predictors. 10 However, there are limitations, such as the low availability at cardiac catheterisation units as well as the associated costs. Another possibility for bifurcation treatment is the use of fractional myocardial flow reserve in the lateral branch functional assessment and intervention requirement.…”

OCT Guidance in Bifurcation Percutaneous Coronary Intervention

“…Most case reports visualise the complex anatomical structure of bifurcation dedicated stents in 3D OCT. Ferrante et al . [ 29 ] used OCT to assess the efficacy of the Tryton dedicated side branch stent in nine patients, and found that malapposed stent struts were more frequently seen at the level of the bifurcation than in the proximal and distal stent in the MV. In particular, the highest proportion of malapposed struts was seen towards the ostium of the side branch [ 29 , 30 ].…”

“…[ 29 ] used OCT to assess the efficacy of the Tryton dedicated side branch stent in nine patients, and found that malapposed stent struts were more frequently seen at the level of the bifurcation than in the proximal and distal stent in the MV. In particular, the highest proportion of malapposed struts was seen towards the ostium of the side branch [ 29 , 30 ]. The following stents are used with provisional SB stenting approach.…”

OCT-guided Percutaneous Coronary Intervention in Bifurcation Lesions

“…OCT has also been used to evaluate the effectiveness of new devices dedicated to bifurcation lesions. The efficacy of the Tryton dedicated side branch stent (Tryton Medical) was tested in small populations[17,18] then more widely in the Prospective, Single Blind, Randomized Controlled Study to Evaluate the Safety and Effectiveness of the Tryton Side Branch Stent Used With DES in the Treatment of De Novo Bifurcation Lesions in the MB and SB in Native Coronaries (TRYTON) trial,[19] which failed to demonstrate superiority of this new stent above conventional provisional stenting. Similarly, OCT was used to evaluate the STENTYS stent (STENTYS SA), a provisional, self-expanding nitinol drug-eluting or bare-metal stent reported to have a good success rate along with a low rate of major adverse cardiac events.…”