title: Healing responses after bifurcation stenting with the dedicated TRYTON Side-Branch Stent™ in combination with XIENCE-V™ stents: a clinical, angiography, fractional flow reserve, and optical coherence tomography study: the PYTON (Prospective evaluation of the TRYTON Side-Branch Stent™ with an additional XIENCE-v™ everolimus-eluting stent in coronary bifurcation lesions) study.
abstract: OBJECTIVE
  We evaluated healing responses with optical coherence tomography (OCT), and clinical and angiographic outcome after bifurcation stenting with the TRYTON Side-Branch Stent™.
  
  
  BACKGROUND
  Dedicated bifurcation stents have been proposed as a potential alternative for treatment of true coronary bifurcation lesions.
  
  
  METHODS
  We 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™ 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), and cardiac death].
  
  
  RESULTS
  LLL (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 four patients (25%), in-segment restenosis in five (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%)].
  
  
  CONCLUSIONS
  The 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™ stent. However, proximal MV edge and ostial SB restenoses together with overall clinical outcomes do not fulfill expectations of a dedicated bifurcation stent. © 2012 Wiley Periodicals, Inc.
authors: Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium. christophe.dubois@uzleuven.be
authors: Christophe
authors: C
authors: Dubois
authors: Tom
authors: T
authors: Adriaenssens
authors: Giovanni
authors: G
authors: Ughi
authors: Stefanus
authors: S
authors: Wiyono
authors: Johan
authors: J
authors: Bennett
authors: Mark
authors: M
authors: Coosemans
authors: Bert
authors: B
authors: Ferdinande
authors: Peter
authors: P
authors: Sinnaeve
authors: Jan
authors: J
authors: D'hooge
authors: Walter
authors: W
authors: Desmet
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents; D017023:Coronary Angiography / Q000379:methods*; D003326:Coronary Circulation / Q000502:physiology*; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D003331:Coronary Vessels / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D054855:Drug-Eluting Stents; D000068338:Everolimus; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology; D008297:Male; D009204:Myocardial Revascularization / Q000379:methods*; D011446:Prospective Studies; D011474:Prosthesis Design; D012039:Regional Blood Flow; D020123:Sirolimus / Q000031:analogs & derivatives* / Q000494:pharmacology; D041623:Tomography, Optical Coherence / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D007166:Immunosuppressive Agents; D000068338:Everolimus; D020123:Sirolimus