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.