title: Placement of Tryton Side Branch Stent only; a new treatment strategy for Medina 0,0,1 coronary bifurcation lesions.
abstract: OBJECTIVE
  We propose a new treatment strategy of Medina 0,0,1 bifurcation lesions using a dedicated side branch stent alone (Tryton Side Branch Stent™) without additional main branch stenting, with the advantage of an optimal ostial side branch coverage without the disadvantage of an excessive amount of metal in the main branch.
  
  
  BACKGROUND
  Medina 0,0,1 lesions are relatively rare and there is no consensus on treatment strategy. Several previous techniques have been described, all with considerable disadvantages.
  
  
  METHODS
  Between October 2009 and November 2011, 12 patients with Medina 0,0,1 lesions treated with Tryton alone were included. Clinical outcomes were reported as all-cause mortality, recurrent myocardial infarction (MI), target vessel revascularization (TVR), target lesion revascularization (TLR), and target vessel failure (TVF; defined as the composite of all-cause mortality, MI, and TVR). Procedural success was defined as successful stent placement with residual stenosis <30%, postprocedural TIMI 3 flow, and no in-hospital TVF.
  
  
  RESULTS
  Mean age was 64 years. Median side branch reference vessel diameter was 2.6 [2.5-3.0] mm (median stenosis 75%). Procedural success was 100%. Median clinical follow-up duration was 868 [470-906] days with just one of the patients suffering from a late adverse clinical outcome: TLR at 427 days, resulting in TVF, TVR, and TLR rates of 8.3%.
  
  
  CONCLUSIONS
  Treatment of Medina 0,0,1 lesions with the Tryton stent alone was associated with a 100% procedural success and only one late clinical adverse event (median follow-up of 868 days). These first positive results need to be confirmed in larger prospective randomized studies.
authors.affiliation: Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Maik J
authors.initials: MJ
authors.lastname: Grundeken
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Agostoni
authors.forename: Maciej
authors.initials: M
authors.lastname: Lesiak
authors.forename: Karel T
authors.initials: KT
authors.lastname: Koch
authors.forename: Michiel
authors.initials: M
authors.lastname: Voskuil
authors.forename: Robbert J
authors.initials: RJ
authors.lastname: de Winter
authors.forename: Joanna J
authors.initials: JJ
authors.lastname: Wykrzykowska
authors.forename: Pieter R
authors.initials: PR
authors.lastname: Stella
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D011474:Prosthesis Design; D015607:Stents; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome
keywords: bifurcation lesions; coronary artery disease; percutaneous coronary intervention