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Tryton Breakfast Symposium:Real World Applications

David G. Rizik, M.D., F.A.C.C., F.S.C.A.I.Chief Scientific Officer

Director of Structural & Coronary InterventionsHonorHealth and the Scottsdale-Lincoln

HealthNetworkHon

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Disclosure Statement

• Abbott  Vascular:  Medical  Advisory  Board,  Research  &  Education  Support.

• Boston  Scientific:  Executive  Physician  Council,  Research  &  Education  Support

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Open strut architecture

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Tryton  Side  Branch  Stent

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Tryton Deployment Sequence1.  Wire  both  vessels  and  pre-­dilate  SB 2.  Position  Tryton

3.  Perform  P.O.T. 4.  Position  DES  and  remove  ‘jailed’  wire

5.  Deploy  DES  and  re-­wire  SB 6.  Simultaneous  Kissing  Balloon

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Tryton Case

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Dedicated SB Stent: ? Value

• Value:  Bringing  the  predictability &  durability seen  in  straight  lesions  to  bifurcation  lesions

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Provisional  (n=  143)

Tryton  (n=  146)

Dedicated Stent: PredictabilityNear elimination of bailout stenting

Généreux et  al.  Catheter  Cardiovasc Interv.  2015  

Tryton  IDE  Trial  Intended  Population

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• Side  Branch  Size:   Significant• Angle:     Narrow  and  Wide• Step-­up:     Large  and  Small

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Which Lesion? Significant

• Significant– Appropriate  for  a  2.5  mm  diameter  stent– >2.25  mm  by  visual  estimate

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Angle:    Wide Angle:    Narrow

Which Lesion? Angle

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SB-­MB  Step-­up:    Large   SB-­MB  Step-­up:    Small

Which Lesion? SB-MB Step-up

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Conclusion

• When  a  dedicated  SB  Stent?Bifurcation  lesions  with  important  Side  Branches

• Procedural  Predictability• Long  term  Durability