Dedicated Bifurcation Stent for the Treatment of Bifurcation Lesions InvolvingLarge Side Branches

Fro Me dio Ka Au He Am Re Le Sy an OBJECTIVES The aim of this study was to prospectively study and confirm the safety and efficacy of the Tryton Side Branch Stent in the treatment of coronary artery bifurcations involving large side branches (SBs). BACKGROUND The TRYTON Pivotal randomized controlled trial (RCT) was designed to compare the Tryton stent with standard provisional SB stenting in large vessels. The trial inadvertently enrolled patients with too small SBs (<2.25 mm). The overall trial did not meet its primary endpoint, because of an increased rate of periprocedural myocardial infarction in the Tryton stent arm. A post hoc analysis restricted to the intended population showed that the trial would have met its endpoint if only patients with SBs $2.25 mm in diameter (by core laboratory quantitative coronary angiography) had been enrolled. METHODS The Tryton Confirmatory Study was a prospective, single-arm extension of the TRYTON Pivotal RCT that enrolled an additional 133 patients treated with the Tryton Side Branch Stent. It was designed to confirm the results of the post hoc analysis and emphasized the inclusion of appropriately sized SBs. The primary endpoint was noninferiority with regard to periprocedural myocardial infarction (creatine kinase myocardial band 3 times the upper limit of normal) compared with a performance goal based on the TRYTON Pivotal RCT. RESULTS Among the 133 enrolled patients, 132 (99.2%) had SBs $2.25 mm. Baseline clinical and angiographic parameters were similar in this study and the RCT. Periprocedural myocardial infarction occurred in 10.5% of patients, which was numerically lower than the provisional group in the TRYTON Pivotal RCT (11.9%). The 95% confidence bounds did not extend beyond the pre-defined performance goal of 17.9%, meeting the noninferiority primary endpoint. CONCLUSIONS The Tryton Confirmatory Study, in conjunctionwith the post hoc analysis of the intended population in the TRYTON Pivotal RCT, supports the safety and efficacy of the Tryton Side Branch Stent for treatment of bifurcation lesions involving large SBs. (J Am Coll Cardiol Intv 2016;9:1338–46) © 2016 by the American College of Cardiology Foundation. m the Cardiovascular Research Foundation, New York, New York; NewYork-Presbyterian Hospital/Columbia University dical Center, New York, New York; Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada; Latvian Centre of Carlogy, Paul Stradins Clinical University Hospital, Riga, Latvia; North Carolina Heart and Vascular, Raleigh, North Carolina; rol Marcinkowski University of Medical Sciences, Pozan, Poland; AZ Maria Middelares, Gent, Belgium; Austin Heart PLLC, stin, Texas; Ziekenhuis Oost-Limburg, Genk, Belgium; Castle Hill Hospital, East Yorkshire, United Kingdom; Wellmont CVA art Institute, Kingsport, Tennessee; AZ Sint Jan, Bruges, Belgium; Department of Cardiology, Onze Lieve Vrouwe Gasthuis, sterdam, The Netherlands; Tryton Medical, Inc., Durham, North Carolina; Monzino Hospital, Milan, Italy; Harvard Clinical search Institute, Beth Israel Deaconess Medical Center, Boston, Massachusetts; and the Dartmouth-Hitchcock Medical Center, banon, New Hampshire. Dr. Généreux has received speaking fees from Abbott Vascular; and is a consultant for Cardiovascular stems. Dr. Kumsars has received speaking fees from AstraZeneca and Tryton Medical. Dr. Lesiak has received speaking d consulting fees from Abbott Vascular, Boston Scientific, Biotronik, B Braun, and AstraZeneca. Dr. Metzger is a consultant for AB BR E V I A T I O N S