A Randomized Trial of a Dedicated Bifurcation Stent Versus Provisional Stenting in the Treatment of Coronary Bifurcation Lesions

Abstract

Provisional stenting should remain the preferred strategy for treatment of non-left main true coronary bifurcation lesions. (Prospective, Single Blind, Randomized Controlled Study to Evaluate the Safety & Effectiveness of the Tryton Side Branch Stent Used With DES in Treatment of de Novo Bifurcation Lesions in the Main Branch & Side Branch in Native Coronaries [TRYTON]; NCT01258972).

2018 ESC/EACTS Guidelines on myocardial revascularization

“…624,625 Several stents, designed specifically for the treatment of bifurcation lesions, have undergone extensive evaluation with promising angiographic and clinical results, though RCTs against current recommended therapy are limited. 626 Further technical details relating to bifurcation PCI are described in the consensus document of the European Bifurcation Club. 627 …”

Clinical outcomes in real‐world patients with bifurcation lesions receiving Xience V everolimus‐eluting stents: Four‐year results from the Xience V USA study

“…[19] However, provisional bifurcation side branch treatment guided by FFR provided no benefit compared to angiography guided provisional treatment [20]. A recent randomized trial showed there was no benefit of a dedicated bifurcation stent compared to traditional, provisional stenting of the side branch [21].…”

Is it possible to further improve clinical results with coronary bifurcation stenting, or what is more important — the technique or the stent?

“…Probably the greatest drawback is the limited range of lengths of the devices, which most frequently results in additional stent(s) implantation, increasing the cost of the procedure. The SB-dedicated stenting with Tryton stent (not the drug-eluting version) did not reach its primary non-inferiority end-point in comparison with regular DES [51]. It demonstrated such non-inferiority only in the group with SB reference diameter more than 2.25 mm.…”