Case based tutorial on bifurcation dedicated stent Tryton placement

1. Fouladvand F, Holy Family Hospital (Ospedale Sacra Famiglia) Hospitaller Order of St. John of God (Ordine Ospedaliero San Giovanni di Dio) Erba, Italy

2. Male 60 y No previous disease • Hypertension • Dyslipidaemia Risk factors Effort angina • Symptoms - angina • V4-V6 - ST Stress test Case presentation • Normal EF • Non hypokinesia • Non valvular alteration Echocardiography • Normal EF • Non hypokinesia Echocardiography

3. • Long stenosis Proximal LAD • Medina 1.1.1 LAD/D1 • Radial approach Coronary angiography • HB 3,5 6F • 2 wires BMW Angioplasty • Basal AP-CRANIAL

4. • Long stenosis Proximal LAD • Medina 1.1.1 LAD/D1 • RAO-Cranial Basal • Radial approach Coronary angiography • HB 3,5 6F • 2 wires BMW Angioplasty

5. • Long stenosis Proximal LAD • Medina 1.1.1 LAD/D1 • AP-Cranial Basal • Radial approach Coronary angiography • HB 3,5 6F • 2 wires BMW Angioplasty

6. Preparation for Tryton Tryton implantation POT Tryton Repositioning wire SB>MB Preparation for DES MB MB DES implantation POT MB DES Recrossing MB DES struts POBA struts DES Kissing balloon Final post-dilatation Strategy • Balloon 2,5 x 30 mm POBA LAD

7. Preparation for Tryton Tryton implantation POT Tryton Repositioning wire SB>MB Preparation for DES MB MB DES implantation POT MB DES Recrossing MB DES struts POBA struts DES Kissing balloon Final post-dilatation Strategy • Balloon 2,5 x 30 mm POBA D1

8. Preparation for Tryton Tryton implantation POT Tryton Repositioning wire SB>MB Preparation for DES MB MB DES implantation POT MB DES Recrossing MB DES struts POBA struts DES Kissing balloon Final post-dilatation Strategy • Ready for Tryton Result post POBA

9. Preparation for Tryton Tryton implantation POT Tryton Repositioning wire SB>MB Preparation for DES MB MB DES implantation POT MB DES Recrossing MB DES struts POBA struts DES Kissing balloon Final post-dilatation Strategy • 3,5/2,5 – 19 mm Advancing Tryton

10. Preparation for Tryton Tryton implantation POT Tryton Repositioning wire SB>MB Preparation for DES MB MB DES implantation POT MB DES Recrossing MB DES struts POBA struts DES Kissing balloon Final post-dilatation Strategy • Carina between 2 mid markers Positioning Tryton

11. Preparation for Tryton Tryton implantation POT Tryton Repositioning wire SB>MB Preparation for DES MB MB DES implantation POT MB DES Recrossing MB DES struts POBA struts DES Kissing balloon Final post-dilatation Strategy • At nominal pressure Releasing Tryton

12. Preparation for Tryton Tryton implantation POT Tryton Repositioning wire SB>MB Preparation for DES MB MB DES implantation POT MB DES Recrossing MB DES struts POBA struts DES Kissing balloon Final post-dilatation Strategy • Acceptable Result after Tryton

13. Preparation for Tryton Tryton implantation POT Tryton Repositioning wire SB>MB Preparation for DES MB MB DES implantation POT MB DES Recrossing MB DES struts POBA struts DES Kissing balloon Final post-dilatation Strategy • NC balloon 3,0 x 15 mm POT PV Tryton

14. Preparation for Tryton Tryton implantation POT Tryton Repositioning wire SB>MB Preparation for DES MB MB DES implantation POT MB DES Recrossing MB DES struts POBA struts DES Kissing balloon Final post-dilatation Strategy • Keep the balloon in Tryton Repositioning wire SB>MB

15. Preparation for Tryton Tryton implantation POT Tryton Repositioning wire SB>MB Preparation for DES MB MB DES implantation POT MB DES Recrossing MB DES struts POBA struts DES Kissing balloon Final post-dilatation Strategy • NC balloon 3,0 x 15 mm POBA LAD

16. Preparation for Tryton Tryton implantation POT Tryton Repositioning wire SB>MB Preparation for DES MB MB DES implantation POT MB DES Recrossing MB DES struts POBA struts DES Kissing balloon Final post-dilatation Strategy • Gently Removing LAD jailed wire

17. Preparation for Tryton Tryton implantation POT Tryton Repositioning wire SB>MB Preparation for DES MB MB DES implantation POT MB DES Recrossing MB DES struts POBA struts DES Kissing balloon Final post-dilatation Strategy • 3,0 x 30 mm DES delivery MB

18. Preparation for Tryton Tryton implantation POT Tryton Repositioning wire SB>MB Preparation for DES MB MB DES implantation POT MB DES Recrossing MB DES struts POBA struts DES Kissing balloon Final post-dilatation Strategy • NC balloon 3,3 x 15 mm POT DES PV

19. Preparation for Tryton Tryton implantation POT Tryton Repositioning wire SB>MB Preparation for DES MB MB DES implantation POT MB DES Recrossing MB DES struts POBA struts DES Kissing balloon Final post-dilatation Strategy • Easily Recrossing MB DES struts

20. Preparation for Tryton Tryton implantation POT Tryton Repositioning wire SB>MB Preparation for DES MB MB DES implantation POT MB DES Recrossing MB DES struts POBA struts DES Kissing balloon Final post-dilatation Strategy • Balloon 2,0 x 15 mm POBA struts DES MB

21. Preparation for Tryton Tryton implantation POT Tryton Repositioning wire SB>MB Preparation for DES MB MB DES implantation POT MB DES Recrossing MB DES struts POBA struts DES Kissing balloon Final post-dilatation Strategy • LAD 2,5 x 30 mm • D1 2,5 x 15 mm Kissing balloon

22. Preparation for Tryton Tryton implantation POT Tryton Repositioning wire SB>MB Preparation for DES MB MB DES implantation POT MB DES Recrossing MB DES struts POBA struts DES Kissing balloon Final post-dilatation Strategy • LAD balloon 2,5 x 30 mm • D1 NC balloon 3,0 x 15 mm Kissing balloon

23. Preparation for Tryton Tryton implantation POT Tryton Repositioning wire SB>MB Preparation for DES MB MB DES implantation POT MB DES Recrossing MB DES struts POBA struts DES Kissing balloon Final post-dilatation Strategy • NC balloon 3,5 x 15 mm Post-dilatation DES MB

24. Final result

25. Final result

26. Final result

27. Final result

Case based tutorial on bifurcation dedicated stent Tryton placement

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Case based tutorial on bifurcation dedicated stent Tryton placement