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D.Rizik, tryton breakfast symposium_real world applications


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D2230 g v01 rev. 1 d.rizik, tryton breakfast symposium_real world applications

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D.Rizik, tryton breakfast symposium_real world applications

  1. 1. Scottsdale-LincolnHealthNetwork 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 Interventions HonorHealth and the Scottsdale-Lincoln HealthNetwork HonorHealth/Scottsdale-LincolnHealthNetwork
  2. 2. Scottsdale-LincolnHealthNetwork Disclosure Statement • Abbott  Vascular:  Medical  Advisory   Board,  Research  &  Education   Support. • Boston  Scientific:  Executive   Physician  Council,  Research  &   Education  Support
  3. 3. Scottsdale-LincolnHealthNetwork Tryton Side Branch Stent “Save  the  Side  Branch  Strategy” Open strut architecture
  4. 4. Scottsdale-LincolnHealthNetwork Phantom Model Deployment Tryton  Side  Branch  Stent
  5. 5. Scottsdale-LincolnHealthNetwork Tryton Deployment Sequence 1.  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
  6. 6. Scottsdale-LincolnHealthNetwork Tryton Case
  7. 7. Scottsdale-LincolnHealthNetwork
  8. 8. Scottsdale-LincolnHealthNetwork
  9. 9. Scottsdale-LincolnHealthNetwork
  10. 10. Scottsdale-LincolnHealthNetwork Dedicated SB Stent: ? Value • Value:  Bringing  the  predictability &   durability seen  in  straight  lesions  to   bifurcation  lesions
  11. 11. Scottsdale-LincolnHealthNetwork Provisional  (n=  143) Tryton  (n=  146) Dedicated Stent: Predictability Near elimination of bailout stenting Généreux et  al.  Catheter  Cardiovasc Interv.  2015   Tryton  IDE  Trial  Intended  Population
  12. 12. Scottsdale-LincolnHealthNetwork Which Lesion? Significant Side Branch • Side  Branch  Size:   Significant • Angle:     Narrow  and  Wide • Step-­up:     Large  and  Small
  13. 13. Scottsdale-LincolnHealthNetwork Which Lesion? Significant • Significant – Appropriate  for  a  2.5  mm  diameter  stent – >2.25  mm  by  visual  estimate
  14. 14. Scottsdale-LincolnHealthNetwork
  15. 15. Scottsdale-LincolnHealthNetwork Angle:    Wide Angle:    Narrow Which Lesion? Angle
  16. 16. Scottsdale-LincolnHealthNetwork SB-­MB  Step-­up:    Large   SB-­MB  Step-­up:    Small Which Lesion? SB-MB Step-up
  17. 17. Scottsdale-LincolnHealthNetwork Conclusion • When  a  dedicated  SB  Stent? Bifurcation  lesions  with  important  Side   Branches • Procedural  Predictability • Long  term  Durability