Outcomes of a dedicated stent in coronary bifurcations with large side branches: A subanalysis of the randomized TRYTON bifurcation study

Abstract

Analysis of the TRYTON Trial cohort of SB ≥2.25 mm supports the safety and efficacy of the Tryton SB stent compared with a provisional stenting strategy in the treatment of bifurcation lesions involving large SBs. © 2015 Wiley Periodicals, Inc.

Anatomical and functional assessment of Tryton bifurcation stent before and after final kissing balloon dilatation: Evaluations by three‐dimensional coronary angiography, optical coherence tomography imaging and fractional flow reserve

“…The SB mean RVD was 1.58 ± 0.41 as assessed by QCA (Table ). A subanalysis of the Tryton randomized trial by Généreux et al showed that 59% of enrolled patients had a QCA‐assessed SB RVD ≤ 2.25 mm (Core Lab QCA) . These findings show expected differences between visual estimates of vessel size and QCA and highlight the need for baseline QCA to enhance adequate patient selection.…”

Dedicated Bifurcation Stent for the Treatment of Bifurcation Lesions Involving Large Side Branches

“…The failure to meet the primary endpoint was due mainly to an increased incidence of periprocedural myocardial infarction (PPMI) in the Tryton stent group. A post hoc analysis of the intended population restricted to lesions involving SBs with a reference vessel diameter $2.25 mm demonstrated superior angiographic results and a numeric reduction in target vessel failure within the noninferiority margin; however, because of the nature (retrospective, non-prespecified) of this subanalysis, an additional prospective study was required to validate these findings (13).…”

“…The Tryton Pivotal RCT was also the largest RCT to exclusively studied bifurcation lesions(12). The pivotal randomized trial(12) and its large SB post hoc analysis(13), in conjunction with the present study, not only demonstrate the safety and efficacy of the Tryton Side Branch…”

“…A closer look at the data revealed that 59% of the patients had SBs that were smaller than the prespecified inclusion criteria. These patients had a disproportionally high incidence of procedure-related creatine kinase myocardial band elevation(13). Patients with too small SBs assigned to the provisional (control) group were treated with appropriately sized angiography balloons, whereas those assigned to the Tryton group were treated with a stent mounted on an oversized balloon.…”

Fork in the road: Are all bifurcations created equal?

“…In this edition of the journal, Genereaux et al present results from the TRYTON study which evaluated routine side branch (SB) stenting with a novel bare metal stent (BMS) designed for true bifurcation lesions (Medina 1,1,1; 1,0,1; 0,1,1) and compared it to a strategy of balloon angioplasty with provisional stenting.…”