PROCEDURAL SUCCESS AND CLINICAL OUTCOME OF TRYTON,A DEDICATED BIFURCATION STENT USE IN COMPLEX BIFURCATION LESIONS IN UNSELECTED PATIENTS: A SINGLE CENTRE REGISTRY DATA

Abstract

Coronary Bifurcation Lesions (CBL) account for approximately of 15% of all lesions treated with Percutaneous Intervention (PCI). While main branch (MB) stent with provisional side branch (SB) stenting is the preferred approach in the treatment of coronary bifurcations, not uncommonly a 2-stent strategy with SB stenting is required to maintain patency of the MB and SB. There remains no consensus on the optimal 2 stent strategy because of paucity in data.Consequently, dedicated bifurcation stents have been designed to treat both the MB and SB without compromising the carina of CBL`s. The Tryton Side-Branch Stent (Tryton Medical, Inc., MA, and USA) is one of the dedicated bifurcations which have shown promising long term outcome in FIM trial and other selective registries. We prospectively evaluated the safety and efficacy of the Tryton Side-Branch Stent in an unselected group of patients who were treated with PCI for CBL within our centre. Data from the in hospital Cardiac Catheter Laboratory Registry between 2009 -2013 identified 38 successive patients who were treated with Tryton Side-Branch Stent. Procedural information was obtained from British Cardiac Intervention Society database. Follow up data was collected by reviewing follow up clinic letters via in hospital database over a mean period of 18 months. Mortality data was verified with Welsh Demographic Service data base. The Tryton stent was successfully deployed in 97% cases with 74% of patients being males, mean age of 71yrs. 92% of cases were done via radial access using 6F sheaths. The indications for PCI were: Stable angina 17(45%), NSTEMI 18(47%) STEMI 3(8%). Of all the CBL, 68% were true bifurcation lesion as per Medina classification. The median angle between the MB and SB was at 60 degrees. Most lesions (75%) were crossed with BMW wires with IVUS used in 7(18%) cases. Final kissing balloon inflation was carried out in 30(79%) of cases. Mean MB and SB stent diameter was 3.5mm and 2.75 respectively. Procedural success was 97% with 1 in-hospital mortality. Both TVR and TLR were at 0% with no cases of stent thrombosis. Most CBL can be safely and efficiently treated with the Tryton dedicated Side Branch stent and is not associated with any significant short or long term major adverse cardiac events. This study demonstrates that dedicated stents can be used in a wide spectrum of clinical presentations and can be safely delivered in default transradial PCI centres.