Side branch healing patterns of the Tryton dedicated bifurcation stent: a 1-year optical coherence tomography follow-up study

• Published in: The International Journal of Cardiovascular Imaging Vol. 30; no. 8; pp. 1445 - 1456
• Main Authors: Grundeken, Maik J., Garcia-Garcia, Hector M., Kraak, Robin P., Woudstra, P., de Bruin, Daniel M., van Leeuwen, Ton G., Koch, Karel T., Tijssen, Jan G., de Winter, Robbert J., Wykrzykowska, Joanna J.
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01.12.2014; Springer Nature B.V
• Subjects: Aged; Cardiac Imaging; Cardiology; Coronary Angiography; Coronary Artery Disease - diagnosis; Coronary Artery Disease - therapy; Coronary Vessels - pathology; Female; Humans; Hyperplasia; Imaging; Male; Medicine; Medicine & Public Health; Metals; Middle Aged; Neointima; Original Paper; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - instrumentation; Predictive Value of Tests; Prosthesis Design; Radiology; Stents; Time Factors; Tomography, Optical Coherence; Treatment Outcome; Vascular Remodeling; Wound Healing; Bifurcation stent; Tryton stent; Bifurcation lesion; Three-dimensional optical coherence tomography; Optical coherence tomography; Coronary bifurcation lesion; Percutaneous coronary intervention; Coronary artery disease
• ISSN: 1569-5794; 1573-0743; 1875-8312
• DOI: 10.1007/s10554-014-0504-y

The bare-metal Tryton Side Branch (SB) Stent™ (Tryton Medical, Durham, NC, USA) is used with a drug-eluting stent (DES) in the main branch (MB) to treat bifurcation lesions. It is argued that a drug-eluting Tryton-version is needed to improve clinical outcomes, although previous registries have shown good clinical results. More insights in neo-intimal hyperplasia (NIH) growth patterns of the Tryton treatment strategy are needed to decide if and where to drug-coat the stent. Ten patients returned for follow-up angiography (mean follow-up time 393 ± 103 days) and optical coherence tomography (OCT) pullbacks from the MB were obtained in all patients and from the SB in six patients. A per-strut analysis showed an uncovered strut rate of 0.7 % and an incompletely-apposed strut rate of 0.8 %. Most incompletely-apposed struts were found at the bifurcation region, in the luminal half facing towards the SB. Mean NIH thickness in the proximal MB, distal MB and SB were 0.14 ± 0.11, 0.19 ± 0.11, and 0.34 ± 0.19 mm, respectively, with a variety of growth patterns observed in the SB. We found good vascular healing of the DES in the MB, while healing was less favourably in the SB part. Furthermore, we observed a variety of NIH growth patterns in this SB part and more studies are needed to investigate the relation between growth patterns and clinical outcomes.