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Stent for left main bifurcation lesions promising at 6 months
New research indicates that combining a Tryton stent with a drug-eluting stent for left main bifurcation disease is feasible and achieves optimal angiographic results, with acceptable procedural safety and 6-month outcomes.
Researchers in the study enrolled 52 consecutive patients (aged 68 ± 11 years; 75% male; 42% unstable angina; SYNTAX score 20 ± 8) with left main disease treated in nine European centers. Medina class was 1, 1, 1 in 33 (63%) patients; 1, 0, 1 in seven (13%); 1, 1, 0 in three (6%); 0, 1, 1 in four (8%); and 0, 0, 1 in one (2%). The Tryton stent (Tryton Medical) on a stepped balloon (diameter 3.5-2.5 mm) was used in 41 of 51 (80%) cases. The mean main vessel stent diameter was 3.4 ± 0.4 mm with an everolimus-eluting stent employed in 30 of 51 (59%) patients. Final kissing balloon dilatation was performed in 48 of 51 cases (94%).
Success was achieved in 51 of 52 patients. Acute gain was 1.52 ± 0.86 mm in the left main and 0.92 ± 0.47 mm in the side branch. Angiographic success occurred in all patients, whereas the procedural success rate reached 94%. Three patients experienced periprocedural MI.
At 6-month follow-up, the target lesion revascularization rate was 12%, almost exclusively due to side branch ostium restenosis; MI was 10%; cardiac death was 2%; and the rate for hierarchical MACE at 6 months was 22%. No definite stent thrombosis occurred.
“It is worth noting that the majority of two-stent techniques employed in these studies were crush and T stenting with under-representation of culotte stenting,” the researchers wrote. “The latter has the potential advantage of a better scaffolding of the distal vessel ostia and at the same time may minimize the number of unopposed struts at the bifurcation.”
Disclosure: The researchers report no relevant financial disclosures.