Case

When Tryton Stent Type Becomes Indicated

by
Alghafek Almorraweh
August 30, 2016
Operator(s)
Alghafek Almorraweh, MD; Feras Ramadan , MD
Affiliation
Albassel Heart Institute , Damascus, Syria
Facility / Institute
Albassel Heart Institute , Damascus, Syria
Clinical History
A 42 year old male patient with no cardiac risk factors, presented with typical chest pain started 4 hours before.initial physical exam BP=110/60mmhg,HR:90/mint,Sat O2=98%cardiac auscultation :S4,chest:clear). ECG showed ↑ST at V1-V4,(with max ST elevation at lead V3, 5mm).
Angiography
1- LM: normal
2- LAD: ostial total occluded (figure 1)
3- LCX: normal
4- RCA: normal (figure 2)
Procedure
A 6Fr, Medtronic Launcher JL 3,5 guiding catheter was used to engage the LM, a bolus dose of Eptifibatide (integrilin) (180 mcg/kg) followed by maintains dose was given IV , A BMW Universal guidewire was positioned into the distal LAD, a 2,5x20mm Trek balloon was used to dilate LAD (figure 3, figure 4),then DES (3*28) at 14 bar was inserted at ostial LAD (figure 5),after that the patient became hypotension with ostial CX lesion (plaque or thrombus shift) (figure 6), second BMW wire inserted to intermediate branch and inflate Balloon (2,5*20) (figure 7), then inflate the ostial CX (figure 8) without any benefit ,after that tryton stent (3,5-3) inserted in the LM to the large intermediate artery (figure 9, figure 10), followed by final kissing balloon (figure 11), with good final result, no residual stenosis with TIMI III flow (figure 12), the BP improved and the patient stabilized well. Follow up one year later he has no symptoms.
Conclusion(s) / Result(s)
Successfully opened the occluded artery with TIMI 3 flow and no residual stenosis.
Comments/Lessons
Each time when we face ostial branch lesion with mismatch between the main branch diameter and the side branch, a side branch stents such as TRYTON may be one successful option for treatment in the cathlab.
Conflicts of Interest
None

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