Author:

Keywords:

coronary bifurcation, dedicated devices, optical coherence tomography, Science & Technology, Life Sciences & Biomedicine, Cardiac & Cardiovascular Systems, Cardiovascular System & Cardiology, MYOCARDIAL-INFARCTION, FRACTURE, Aged, Antineoplastic Agents, Coronary Angiography, Coronary Circulation, Coronary Stenosis, Coronary Vessels, Drug-Eluting Stents, Everolimus, Female, Humans, Immunosuppressive Agents, Male, Myocardial Revascularization, Prospective Studies, Prosthesis Design, Regional Blood Flow, Sirolimus, Tomography, Optical Coherence, Treatment Outcome, 1102 Cardiorespiratory Medicine and Haematology, Cardiovascular System & Hematology, 3201 Cardiovascular medicine and haematology

Abstract:

ObjectivesWe evaluated healing responses with optical coherence tomography (OCT), and clinical and angiographic outcome after bifurcation stenting with the TRYTON Side-Branch Stent(TM) .BackgroundDedicated bifurcation stents have been proposed as a potential alternative for treatment of true coronary bifurcation lesions. MethodsWe treated 20 consecutive patients with coronary bifurcation lesions and significant involvement of the side-branch (SB) with the TRYTON Stent and an additional XIENCE-V(TM) everolimus-eluting stent. At 9 months, we assessed the ratio of uncovered to total stent struts (RUTSS) with OCT, angiographic late luminal loss (LLL), and in-stent and in-segment restenosis. Clinical endpoints at 1 year included major adverse cardiac events (MACE) and their components (target lesion revascularization (TLR), myocardial infarction (MI), cardiac death).ResultsLLL (N=16) was 0.34 (0.17;0.46), 0.29 (0.24;0.48) and 0.57 (0.29;0.73)mm in the proximal main vessel (MV), distal MV and SB, respectively. In-bifurcation binary in-stent restenosis occurred in 4 patients (25%), in-segment restenosis in 5 (31.25%). The RUTSS (N=13) was 4.0±5.8, 0.7±1.3, 0 and 2.5±3.6% in the proximal MV, distal MV, SB and polygon of confluence, respectively. At 1 year, MACE occurred in 5 (25%) (4 TLR (20%), 3 MI (15%)).ConclusionThe homogeneous stent strut coverage and the low LLL in the MV reflect proper healing characteristics of the TRYTON Stent in combination with the XIENCE-V(TM) stent. However, proximal MV edge and ostial SB restenoses together with overall clinical outcomes do not fulfil expectations of a dedicated bifurcation stent. © 2012 Wiley Periodicals, Inc.