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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

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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

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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%

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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

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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)

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