title: Acute procedural and six-month clinical outcome in patients treated with a dedicated bifurcation stent for left main stem disease: the TRYTON LM multicentre registry.
abstract: OBJECTIVE
  Tryton side branch (SB) reverse culotte stenting has been employed for the treatment of left main (LM) stem bifurcations in patients at high risk for bypass surgery. The aim of this study was to assess acute angiographic results and six-month clinical outcome after implantation of the Tryton stent in the LM.
  
  
  RESULTS
  We studied 52 consecutive patients with LM disease treated in nine European centres. Angiographic and clinical data analysis was performed centrally. Fifty-one of 52 patients (age 68±11 yrs, 75% male, 42% unstable angina, SYNTAX score 20±8) were successfully treated with the Tryton stent. Medina class was 1,1,1 in 33 (63%), 1,0,1 in 7 (13%), 1,1,0 in 3 (6%), 0,1,1 in 8 (4%) and 0,0,1 in 1 (2%). The Tryton stent on a stepped balloon (diameter 3.5-2.5 mm) was used in 41/51 (80%) of cases. The mean main vessel stent diameter was 3.4±0.4 mm with an everolimus-eluting stent employed in 30/51 (59%) of cases. Final kissing balloon dilatation was performed in 48/51 (94%). Acute gain was 1.52±0.86 mm in the LM and 0.92±0.47 mm in the SB. The angiographic success rate was 100%; the procedural success rate reached 94%. Periprocedural MI occurred in three patients. At six-month follow-up, the TLR rate was 12%, MI 10% and cardiac death 2%. The hierarchical MACE rate at six months was 22%. No cases of definite stent thrombosis occurred.
  
  
  CONCLUSIONS
  The use of the Tryton stent for treatment of LM bifurcation disease in combination with a conventional drug-eluting stent is feasible and achieves an optimal angiographic result. Safety of the procedure and six-month outcome are acceptable in this high-risk lesion PCI. Further safety and efficacy studies with long-term outcome assessment of this strategy are warranted.
authors.affiliation: Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Michael
authors.initials: M
authors.lastname: Magro
authors.forename: Chrysafios
authors.initials: C
authors.lastname: Girasis
authors.forename: Antonio L
authors.initials: AL
authors.lastname: Bartorelli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarantini
authors.forename: Filippo
authors.initials: F
authors.lastname: Russo
authors.forename: Daniela
authors.initials: D
authors.lastname: Trabattoni
authors.forename: Gianpiero
authors.initials: G
authors.lastname: D'Amico
authors.forename: Mario
authors.initials: M
authors.lastname: Galli
authors.forename: Alfredo
authors.initials: A
authors.lastname: Gómez Juame
authors.forename: Manuel
authors.initials: M
authors.lastname: de Sousa Almeida
authors.forename: Cihan
authors.initials: C
authors.lastname: Simsek
authors.forename: David
authors.initials: D
authors.lastname: Foley
authors.forename: Jeroen
authors.initials: J
authors.lastname: Sonck
authors.forename: Maciej
authors.initials: M
authors.lastname: Lesiak
authors.forename: Peter
authors.initials: P
authors.lastname: Kayaert
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.forename: Robert-Jan
authors.initials: RJ
authors.lastname: van Geuns
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D002317:Cardiovascular Agents / Q000008:administration & dosage; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D054855:Drug-Eluting Stents; D005060:Europe; D000068338:Everolimus; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D012042:Registries; D012189:Retrospective Studies; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents; D000068338:Everolimus; D020123:Sirolimus