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Bifurcation Lesion Treatment Option: Insights From Clinical
Literature James Hermiller, MD, FACC, FSCAISt Vincent Medical
GroupSt Vincent Heart Center of IndianaIndianapolis, INPresentation
Theater: Tryton Pivotal: Randomized Trial and Confirmatory Study
Implications for Everyday Practice Tuesday, October 13, 201511:53
AM - 12:02 PMRoom: Moscone South, Exhibit Hall, Presentation
Theater 4Presentation Theater Programs
J Hermiller MD #1
Disclosure Statement of Financial InterestGrant/Research
Support
Consulting Fees/HonorariaEdwards, Medtronic, Abbott, St Jude,
BSCEdwards, Medtronic, Abbott, St Jude, BSC
Within the past 12 months, I or my spouse/partner have had a
financial interest/arrangement or affiliation with the
organization(s) listed below.Affiliation/Financial
RelationshipCompany
J Hermiller MD #2
Key PointsBifurcation Lesions: Continues to be a problem we dont
have the right tools
J Hermiller MD #Key PointsBifurcation Lesions: Continues to be
problem Only Lesion Subset Not Routinely StentedCombined
Literature: Supports Provisional over 2 Stent StrategiesStudy
Population Primarily Focused on Small SBBBC 1Nordic 1Studies with
Large SB Favors 2 Stent ApproachDK Crush2 Stent Simple Dedicated
StentDedicated Side Branch Stent: Focused on Providing Straight
Forward 2 stent solution
J Hermiller MD #Bifurcation Lesions are CommonAll Comers
Studies% Patients% LesionsLeaders Trial1,229.1%21.6%Nobori
2317.5%16.9%xSearch422.2%N/A Average22.9%19.3%1. Windecker et al.
Lancet 2008; 372: 1163732. Wykrzykowska, EuroPCR 093. Danzi,
EuroPCR 094. Serruys, ACC 08
J Hermiller MD #Bifurcation Lesions Yield Complications
Thrombosis RateIncidence: 3.6-3.9%Hazard Ratio:
4.6-6.5Restenosis RatesAngiographic 20-40%
J Hermiller MD #6
Bifurcation Lesions: Large Variation: Disease, Angle &
Diameter
Case Courtesy of Drs Kutcher & Holland, USA
Courtesy of P Brunel, France
Courtesy of Dr. Dumonteil, France
Courtesy of Prof. R. Kornowski, Israel
Courtesy of Dr. Th. Lefvre, France
Courtesy of Dr. Schulze, Germany
Courtesy of Dr. M. Lesiak, Poland
Courtesy of Drs. E. Grbe - R. Mller, Germany
J Hermiller MD #Multiple Treatment StrategiesImplementation:
High Variability/Poorly Characterized
J Hermiller MD #
J Hermiller MD #
Forest plots from the included trials. Odds ratios of target
vessel revascularization (A), and main vessel restenosis (B) in the
large side branch subgroup (patients with side branch diameter 2.5
mm)
SB