Tryton: Addressing the Challenge of Bifurcation Stenting

Dean J. Kereiakes, M.D.Medical Director, The Christ Hospital Heart and Vascular Center and the Lindner Research Center , Cincinnati, OhioProfessor of Medicine, Ohio State University

• Modest Consulting Fees• Significant Consulting Fees• Significant Consulting Fees• Significant Consulting Fees• Significant Consulting Fees• Significant Consulting Fees• Major Stock Shareholder/Equity

• HCRI• Boston Scientific• Abbott Vascular• Svelte Medical Systems, Inc.• Janssen Research & Development LLC• Sanofi-Aventis U.S. LLC• Ablative Solutions, Inc.

Affiliation/Financial Relationship Company

Disclosure Statement of Financial InterestWithin the past 12 months, I or my spouse/partner have had a financial interest/arrangement or affiliation with the organization(s) listed below.

Tryton-The Vision: To treat spectrum of Bifurcation Lesions with the Same

Predictability and Durability as Straight Lesions

Bifurcation Lesions• Bifurcation lesions are characterized by

variable and complex anatomy:

FocalDiffuse Angulated

Calcified

Clinical Segmentation- Plaque Distribution Classifications -

Duke Plaque Distribution Classification -

Type F:Pre-Branch & Ostial

Type A:Pre-Branch

(ICPS Type 3)

Type B:Post-Branch

(ICPS Type 4a)

Type C:Parent Vessel Only

(ICPS Type 2)

Type D:Bifurcation

(ICPS Type 1)

Type E:Ostial

(ICPS Type 4b)

Sources: Popma 1994; Baim TCT 2003

TrueBifurcation

ICPS

*

*

Bifurcation Disease Strategy, Morice, TCT 2005

*

Bifurcation Stenting Techniques with Workhorse Stents

T Stenting V Stenting Y Stenting Culotte * Crush*

Kissing Stent* *”gap” coverage

Complex Bifurcation Disease:Addressing with workhorse DES makes one ‘MADS’!

Catheter and Cardio Interventions 71:175–183 (2008)

Unstented Vessel area versus Bifurcation angle

0

5

10

15

20

25

30

35

0 10 20 30 40 50 60 70 80 90

Bifurcation Angle (degrees)

Uns

tent

ed v

esse

l are

a (m

m^2

)

As bifurcation angle changes from 90º, unstented vessel area

increases rapidly with “workhorse stents”

Suboptimal Coverage & Drug delivery with Workhorse Stents

0 10 20 30 40 50 60 70 80 .

Bifurcation Angle (degrees)

UnstentedVessel Area

90

Tryton Side Branch Stent

Transition Zone

Side Branch Zone

Main Branch Zone

8 mm 4.5 mm 6.5 mm

For Investigational Use Only in the United States For Investigational Use Only in the United States

Tryton Deployed - Side Branch Secured

Position Main Branch Stent

Complete Lesion Coverage

Tryton Sidebranch Stent

Symposium Agenda

Thank You