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Jens  Flensted  Lassen  MD,  PH.D.,  FESC.
Clinical Director,  Associated  professor  
Cardiac Catheterization Laboratory
Department  of  Cardiology,  The  Heart  Centre,  
Rigshospitalet,  University of  Copenhagen  
Copenhagen,  Denmark
Breakfast  Meeting:  Establising the  New  Standard:  
Definitive  Treatment  for  Complex  Bifurcation  Lesions.
(Sponsered by  Tryton medical,  Inc.)
.
TCT2016,  October  30.  2016,  Washington  DC.  USA
Importance  of  Side  Branch  Ostial  
Scaffolding
Disclosure  Statement  of  Financial  Interest
I,  (Jens  Flensted  Lassen)  DO  NOT  have  a  
financial  interest/arrangement  or  
affiliation  with  one  or  more  organizations  
that  could  be  perceived  as  a  real  or  
apparent  conflict  of  interest  in  the  
context  of  the  subject  of  this  
presentation.
Disclosure  Statement  of  Financial  Interest
…….  BUT  !!!
I,  (Jens  Flensted  Lassen)  am  a  Board  
member  and  one  of  the  Directors  of  the  
European  Bifurcation  Club  (EBC)  and  my  
view  on  bifurcation  stenting  is  heavily  
influenced  by  the  thoughts  and  
consensus  statements  of  EBC.
STRESS-­trial  (1994)  and  Benestent (1994)
≈  Tryton  Pivotal  (2015)  
Instent restenose
Norstent Trial  (n=9013)
• Workhorse  DES:  
Optimized  for  Straight  Lesions
Poorly  Suited  to  of  Bifurcation  Lesions
• Wide  Variety  of  Techniques  Required
Poorly  Characterized  Inconsistently  Performed:
Crush,  Culotte,  reverse  Culotte,  internal  crush,  
reverse  crush,  T,  provisional  T,  TAP,  TAP  and  
protusion,  Y,  extended  Y,  V,  SKS,  double  barrel,  
Helqvist,  sleeve,  modified  crush,  Buchbinder,  mini  
crush,  reverse  mini  crush,  short  back  and  sides,  
DK  crush,  flower,  etc.,  etc.
Treating  Bifurcation  Lesions
Why  is  it  difficult  to  evaluate?
Crush  Technique
Courtesy  of  J.  Ormiston
Not  all  2  stent  techniques  are  the  same
Stents  not  designed  for  bifurcation
Triple  layer
Limited  scaffolding
Nordic  II:  Localization  of  In-­Stent  
Restenosis  at  8-­Month  Follow-­up
Angiographic restenosis*  at  8  
months
Nordic-­Baltic  Bifurcation  Study  IV
Binary restenosis ≥  50%  diameter  stenosis
QCA  by  dedicated bifurcation analysis.  Medis QAngioXA 7.3
1.3% 0.7%
1.3%1.3%
n  =  153 n  =  154
Provisional SB  stent technique Two-­stent  technique (Culotte/T)
niels.holm@clin.au.dk
5.2%  20.3%
What  is  the  ideal  technique  or  the  ideal  device  for  coronary  
bifurcation  treatment  and  does  one  strategy  or  device  fit  all?  
Tryton  Stent
Designed  for  all  coronary  bifurcations
Ostial  Scaffolding >3.5  mm
>4.5  mm
Expansion  range
No  Angle  Limitations
Summary  &  Conclusion
• Tryton  stent  was  designed  to  accommodate  
variations  in  vessel  caliber  and  angle  while  
providing  main  vessel  stent-­like  scaffolding  
to  the  ostium  and  side  branch.
• The  in  vitro  results  have  been  confirmed  in  
daily  clinical  practice.
• One  technique  may  fit  all  bifurcations  – if  the  
side  branch  is  large  enough.

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J.Lassen, importance of side branch ostial scaffolding

  • 1. Jens  Flensted  Lassen  MD,  PH.D.,  FESC. Clinical Director,  Associated  professor   Cardiac Catheterization Laboratory Department  of  Cardiology,  The  Heart  Centre,   Rigshospitalet,  University of  Copenhagen   Copenhagen,  Denmark Breakfast  Meeting:  Establising the  New  Standard:   Definitive  Treatment  for  Complex  Bifurcation  Lesions. (Sponsered by  Tryton medical,  Inc.) . TCT2016,  October  30.  2016,  Washington  DC.  USA Importance  of  Side  Branch  Ostial   Scaffolding
  • 2. Disclosure  Statement  of  Financial  Interest I,  (Jens  Flensted  Lassen)  DO  NOT  have  a   financial  interest/arrangement  or   affiliation  with  one  or  more  organizations   that  could  be  perceived  as  a  real  or   apparent  conflict  of  interest  in  the   context  of  the  subject  of  this   presentation.
  • 3. Disclosure  Statement  of  Financial  Interest …….  BUT  !!! I,  (Jens  Flensted  Lassen)  am  a  Board   member  and  one  of  the  Directors  of  the   European  Bifurcation  Club  (EBC)  and  my   view  on  bifurcation  stenting  is  heavily   influenced  by  the  thoughts  and   consensus  statements  of  EBC.
  • 4. STRESS-­trial  (1994)  and  Benestent (1994) ≈  Tryton  Pivotal  (2015)  
  • 6.
  • 8. • Workhorse  DES:   Optimized  for  Straight  Lesions Poorly  Suited  to  of  Bifurcation  Lesions • Wide  Variety  of  Techniques  Required Poorly  Characterized  Inconsistently  Performed: Crush,  Culotte,  reverse  Culotte,  internal  crush,   reverse  crush,  T,  provisional  T,  TAP,  TAP  and   protusion,  Y,  extended  Y,  V,  SKS,  double  barrel,   Helqvist,  sleeve,  modified  crush,  Buchbinder,  mini   crush,  reverse  mini  crush,  short  back  and  sides,   DK  crush,  flower,  etc.,  etc. Treating  Bifurcation  Lesions Why  is  it  difficult  to  evaluate?
  • 9. Crush  Technique Courtesy  of  J.  Ormiston Not  all  2  stent  techniques  are  the  same Stents  not  designed  for  bifurcation Triple  layer Limited  scaffolding
  • 10. Nordic  II:  Localization  of  In-­Stent   Restenosis  at  8-­Month  Follow-­up
  • 11. Angiographic restenosis*  at  8   months Nordic-­Baltic  Bifurcation  Study  IV Binary restenosis ≥  50%  diameter  stenosis QCA  by  dedicated bifurcation analysis.  Medis QAngioXA 7.3 1.3% 0.7% 1.3%1.3% n  =  153 n  =  154 Provisional SB  stent technique Two-­stent  technique (Culotte/T) niels.holm@clin.au.dk 5.2%  20.3%
  • 12. What  is  the  ideal  technique  or  the  ideal  device  for  coronary   bifurcation  treatment  and  does  one  strategy  or  device  fit  all?  
  • 13. Tryton  Stent Designed  for  all  coronary  bifurcations Ostial  Scaffolding >3.5  mm >4.5  mm Expansion  range No  Angle  Limitations
  • 14. Summary  &  Conclusion • Tryton  stent  was  designed  to  accommodate   variations  in  vessel  caliber  and  angle  while   providing  main  vessel  stent-­like  scaffolding   to  the  ostium  and  side  branch. • The  in  vitro  results  have  been  confirmed  in   daily  clinical  practice. • One  technique  may  fit  all  bifurcations  – if  the   side  branch  is  large  enough.