Case based tutorial on bifurcation dedicated stent Tryton placement
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Case based tutorial on bifurcation dedicated stent Tryton placement

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The presentation describes step-by-step technic implantation of dedicated bifurcation stent - Tryton. ...

The presentation describes step-by-step technic implantation of dedicated bifurcation stent - Tryton.

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  • 1. Fouladvand F, Holy Family Hospital (Ospedale Sacra Famiglia) Hospitaller Order of St. John of God (Ordine Ospedaliero San Giovanni di Dio) Erba, Italy
  • 2. Male 60 y No previous disease • Hypertension • Dyslipidaemia Risk factors Effort angina • Symptoms - angina • V4-V6 - ST Stress test Case presentation • Normal EF • Non hypokinesia • Non valvular alteration Echocardiography • Normal EF • Non hypokinesia Echocardiography
  • 3. • Long stenosis Proximal LAD • Medina 1.1.1 LAD/D1 • Radial approach Coronary angiography • HB 3,5 6F • 2 wires BMW Angioplasty • Basal AP-CRANIAL
  • 4. • Long stenosis Proximal LAD • Medina 1.1.1 LAD/D1 • RAO-Cranial Basal • Radial approach Coronary angiography • HB 3,5 6F • 2 wires BMW Angioplasty
  • 5. • Long stenosis Proximal LAD • Medina 1.1.1 LAD/D1 • AP-Cranial Basal • Radial approach Coronary angiography • HB 3,5 6F • 2 wires BMW Angioplasty
  • 6. Preparation for Tryton Tryton implantation POT Tryton Repositioning wire SB>MB Preparation for DES MB MB DES implantation POT MB DES Recrossing MB DES struts POBA struts DES Kissing balloon Final post-dilatation Strategy • Balloon 2,5 x 30 mm POBA LAD
  • 7. Preparation for Tryton Tryton implantation POT Tryton Repositioning wire SB>MB Preparation for DES MB MB DES implantation POT MB DES Recrossing MB DES struts POBA struts DES Kissing balloon Final post-dilatation Strategy • Balloon 2,5 x 30 mm POBA D1
  • 8. Preparation for Tryton Tryton implantation POT Tryton Repositioning wire SB>MB Preparation for DES MB MB DES implantation POT MB DES Recrossing MB DES struts POBA struts DES Kissing balloon Final post-dilatation Strategy • Ready for Tryton Result post POBA
  • 9. Preparation for Tryton Tryton implantation POT Tryton Repositioning wire SB>MB Preparation for DES MB MB DES implantation POT MB DES Recrossing MB DES struts POBA struts DES Kissing balloon Final post-dilatation Strategy • 3,5/2,5 – 19 mm Advancing Tryton
  • 10. Preparation for Tryton Tryton implantation POT Tryton Repositioning wire SB>MB Preparation for DES MB MB DES implantation POT MB DES Recrossing MB DES struts POBA struts DES Kissing balloon Final post-dilatation Strategy • Carina between 2 mid markers Positioning Tryton
  • 11. Preparation for Tryton Tryton implantation POT Tryton Repositioning wire SB>MB Preparation for DES MB MB DES implantation POT MB DES Recrossing MB DES struts POBA struts DES Kissing balloon Final post-dilatation Strategy • At nominal pressure Releasing Tryton
  • 12. Preparation for Tryton Tryton implantation POT Tryton Repositioning wire SB>MB Preparation for DES MB MB DES implantation POT MB DES Recrossing MB DES struts POBA struts DES Kissing balloon Final post-dilatation Strategy • Acceptable Result after Tryton
  • 13. Preparation for Tryton Tryton implantation POT Tryton Repositioning wire SB>MB Preparation for DES MB MB DES implantation POT MB DES Recrossing MB DES struts POBA struts DES Kissing balloon Final post-dilatation Strategy • NC balloon 3,0 x 15 mm POT PV Tryton
  • 14. Preparation for Tryton Tryton implantation POT Tryton Repositioning wire SB>MB Preparation for DES MB MB DES implantation POT MB DES Recrossing MB DES struts POBA struts DES Kissing balloon Final post-dilatation Strategy • Keep the balloon in Tryton Repositioning wire SB>MB
  • 15. Preparation for Tryton Tryton implantation POT Tryton Repositioning wire SB>MB Preparation for DES MB MB DES implantation POT MB DES Recrossing MB DES struts POBA struts DES Kissing balloon Final post-dilatation Strategy • NC balloon 3,0 x 15 mm POBA LAD
  • 16. Preparation for Tryton Tryton implantation POT Tryton Repositioning wire SB>MB Preparation for DES MB MB DES implantation POT MB DES Recrossing MB DES struts POBA struts DES Kissing balloon Final post-dilatation Strategy • Gently Removing LAD jailed wire
  • 17. Preparation for Tryton Tryton implantation POT Tryton Repositioning wire SB>MB Preparation for DES MB MB DES implantation POT MB DES Recrossing MB DES struts POBA struts DES Kissing balloon Final post-dilatation Strategy • 3,0 x 30 mm DES delivery MB
  • 18. Preparation for Tryton Tryton implantation POT Tryton Repositioning wire SB>MB Preparation for DES MB MB DES implantation POT MB DES Recrossing MB DES struts POBA struts DES Kissing balloon Final post-dilatation Strategy • NC balloon 3,3 x 15 mm POT DES PV
  • 19. Preparation for Tryton Tryton implantation POT Tryton Repositioning wire SB>MB Preparation for DES MB MB DES implantation POT MB DES Recrossing MB DES struts POBA struts DES Kissing balloon Final post-dilatation Strategy • Easily Recrossing MB DES struts
  • 20. Preparation for Tryton Tryton implantation POT Tryton Repositioning wire SB>MB Preparation for DES MB MB DES implantation POT MB DES Recrossing MB DES struts POBA struts DES Kissing balloon Final post-dilatation Strategy • Balloon 2,0 x 15 mm POBA struts DES MB
  • 21. Preparation for Tryton Tryton implantation POT Tryton Repositioning wire SB>MB Preparation for DES MB MB DES implantation POT MB DES Recrossing MB DES struts POBA struts DES Kissing balloon Final post-dilatation Strategy • LAD 2,5 x 30 mm • D1 2,5 x 15 mm Kissing balloon
  • 22. Preparation for Tryton Tryton implantation POT Tryton Repositioning wire SB>MB Preparation for DES MB MB DES implantation POT MB DES Recrossing MB DES struts POBA struts DES Kissing balloon Final post-dilatation Strategy • LAD balloon 2,5 x 30 mm • D1 NC balloon 3,0 x 15 mm Kissing balloon
  • 23. Preparation for Tryton Tryton implantation POT Tryton Repositioning wire SB>MB Preparation for DES MB MB DES implantation POT MB DES Recrossing MB DES struts POBA struts DES Kissing balloon Final post-dilatation Strategy • NC balloon 3,5 x 15 mm Post-dilatation DES MB
  • 24. Final result
  • 25. Final result
  • 26. Final result
  • 27. Final result