Safety and efficacy of the Tryton Side Branch Stent™ for the treatment of coronary bifurcation lesions: an update.

INTRODUCTION: Percutaneous coronary interventions (PCIs) involving coronary bifurcation lesions are associated with adverse outcomes compared with non-bifurcation lesions. The Tryton Side Branch Stent has been developed to improve clinical outcomes after bifurcation PCI. Areas covered: We will discuss observational data (clinical registries and intravascular imaging studies) and randomized data from the TRYTON trial (comparing Tryton [used in combination with a main branch drug-eluting stent (DES)] with side branch balloon angioplasty [in combination with a main branch DES; also referred to the provisional strategy]). Expert commentary: The published data showed that the use of Tryton was feasible (successful stent placement in ~95%) and safe (stent thrombosis rates ~0.5% at 9-12 months; no cardiac deaths in the TRYTON trial). Its use resulted in excellent acute angiographic results. However, the TRYTON trial also showed that due to neo-intimal tissue growth, luminal dimension at 9 months were similar between Tryton and the provisional strategy. Furthermore, the trial showed an increased risk of peri-procedural myocardial infarction when Tryton was used in small side branches. Based on all data available, the provisional strategy should still be considered as the default strategy in the majority of bifurcation cases, although the use of Tryton may be considered in complex bifurcation anatomies with extensive disease in large side branches, especially when the device will be further improved by a drug-coating.