Prospective, Single Blind, Rand Controlled Study to Evaluate the Safety & Effectness of Tryton Side Branch Stent Used With DES Treatmt of de Novo Bifurcation Lesions in MB & SB in Native Coronaries (TRYTON)
Primary Purpose
Coronary Atherosclerosis of Native Coronary Artery, Bifurcation Lesions: de Novo Lesions of the Main and Side Branch of Native Coronary Artery
Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Tryton Side Branch Stent with main branch DES
POBA
Sponsored by
About this trial
This is an interventional treatment trial for Coronary Atherosclerosis of Native Coronary Artery focused on measuring Bifurcation lesions
Eligibility Criteria
Inclusion Criteria:
- The patient must be ≥18 and ≤ 90 years of age;
- Symptomatic ischemic heart disease (CCS class 1-4, Braunwald Class IB, IC, IIB, IIC, IIIB, IIIC, and/or have objective evidence of myocardial ischemia);
- Acceptable candidate for CABG;
- Intent to treat the side branch of the target bifurcation based on angiographic evaluation;
- The patient is willing to comply with specified follow-up evaluations;
- The patient or legally authorized representative has been informed of the nature of the study, agrees to its provisions and has been provided written informed consent, approved by the appropriate Medical Ethics Committee (MEC) or Institutional Review Board (IRB).
- Planned use of one of the following approved and commercially available drug-eluting stents for subject's index procedure: CYPHER®, ENDEAVOR® RESOLUTE, PROMUS® or PROMUS® ELEMENT, XIENCE™ V or XIENCE PRIME.
General Exclusion Criteria
- Pregnant or nursing patients and those who plan pregnancy in the period up to 1 year following index procedure. Female patients of child-bearing potential must have a negative pregnancy test done within 7 days prior to the index procedure per site standard test;
- Patient has had a known diagnosis of STEMI acute myocardial infarction (AMI) within 72 hours preceding the index procedure or >72 hours preceding the index procedure and CK and CK-MB have not returned to within normal limits at the time of procedure;
- Patients with non-STEMI within 7 days prior to index procedure with continued CK-MB elevation;
- Patients with non-target lesion PCI within 7 days prior to index procedure with continued CK-MB elevation;
- Impaired renal function (serum creatinine >2.5 mg/dL or 221 μmol/l) or on dialysis;
- Platelet count <100,000 cells/mm3 or >700,000 cells/mm3 or a WBC <3,000 cells/mm3;
- Patient has a history of bleeding diathesis or coagulopathy or patients in whom anti-platelet and/or anticoagulant therapy is contraindicated, or any other significant medical condition which in the Investigator's opinion may interfere with the patient's optimal participation in the study;
- Patient has received an organ transplant or is on a waiting list for any organ transplant;
- Patient has other medical illness (e.g., cancer, known malignancy, or congestive heart failure) or known history of substance abuse (alcohol, cocaine, heroin etc.) that may cause non-compliance with the protocol, confound the data interpretation or is associated with a limited life expectancy (i.e., less than 1 year);
- Patient has a known hypersensitivity or contraindication to aspirin, heparin/bivalirudin, clopidogrel/ticlopidine, prasugrel, stainless steel alloy, cobalt-chromium alloy, rapamycin, everolimus, zotarolimus, paclitaxel, and/or contrast sensitivity that cannot be adequately pre-medicated;
- Patient presents with cardiogenic shock or cardiac arrhythmias that create hemodynamic instability;
- Patient in whom a surgical or other procedure is planned within the next year which would require discontinuation of dual antiplatelet therapy;
- Currently participating in another investigational drug or device study or patient inclusion in another investigational drug or device study where the primary endpoint of the study has not been reached.
Sites / Locations
- Jeffery Moses
Arms of the Study
Arm 1
Arm 2
Arm Type
Active Comparator
Experimental
Arm Label
Angioplasty POBA
Tryton Side Branch Stent
Arm Description
Side Branch balloon angioplasty with main branch DES
Side Branch treated with Tryton Side Branch Stent with main branch DES
Outcomes
Primary Outcome Measures
Target Vessel Failure (TVF)
Secondary Outcome Measures
In-segment % diameter stenosis of the Tryton SB compared to side branch balloon angioplasty
Full Information
NCT ID
NCT01258972
First Posted
December 9, 2010
Last Updated
October 17, 2016
Sponsor
Tryton Medical, Inc.
1. Study Identification
Unique Protocol Identification Number
NCT01258972
Brief Title
Prospective, Single Blind, Rand Controlled Study to Evaluate the Safety & Effectness of Tryton Side Branch Stent Used With DES Treatmt of de Novo Bifurcation Lesions in MB & SB in Native Coronaries
Acronym
TRYTON
Official Title
TRYTON PIVOTAL IDE Coronary Bifurcation Extended Access Study
Study Type
Interventional
2. Study Status
Record Verification Date
April 2016
Overall Recruitment Status
Completed
Study Start Date
December 2010 (undefined)
Primary Completion Date
November 2014 (Actual)
Study Completion Date
October 2016 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Tryton Medical, Inc.
4. Oversight
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
The Tryton Side Branch Stent System has been designed to address the procedural difficulty surrounding treatment of bifurcation lesions and to ensure patency of the side branch with similar performance capabilities (e.g., tracking, radiopacity, coverage and radial strength) that are currently available with conventional coronary stents designed for straight (non bifurcation) lesions.
The Tryton Side Branch Stent is intended to treat and maintain patency in the side branch/carina by providing better ostial side branch conformability and is intended for use in conjunction with currently approved balloon-expandable drug-eluding stents for treatment of the main branch.
Detailed Description
The use of drug-eluding stents in the treatment of bifurcation lesions suggests that DES reduces the rate of restenosis int he main branch (5-10%); however, results int he side branch are not optimal. A study of T stenting in true bifurcation lesions showed a restenosis rate int he main branch of approximately 6% using the CYPHER stent. However, the same study demonstrated that the restenosis rate remained high int he side branch (20%) despite stent implantation and when restenosis occurs, it is generally located at the ostium of the side branch. Further, in half the cases where PTCA alone was the intended strategy for the side branch, a side branch stent had to be placed to address sub-optimal procedural results.
These findings are consistent with previous metal stent studies and suggest the best long-term results are obtained when a side branch stent is not placed. This study and others suggest that the outcomes are related to the way the stents sit within in the vessel; and therefore a stent designed specifically for bifurcation lesions will be needed to reduce restenosis rates and improve long-term outcomes.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Coronary Atherosclerosis of Native Coronary Artery, Bifurcation Lesions: de Novo Lesions of the Main and Side Branch of Native Coronary Artery
Keywords
Bifurcation lesions
7. Study Design
Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Masking
Participant
Allocation
Randomized
Enrollment
133 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Angioplasty POBA
Arm Type
Active Comparator
Arm Description
Side Branch balloon angioplasty with main branch DES
Arm Title
Tryton Side Branch Stent
Arm Type
Experimental
Arm Description
Side Branch treated with Tryton Side Branch Stent with main branch DES
Intervention Type
Device
Intervention Name(s)
Tryton Side Branch Stent with main branch DES
Intervention Description
Tryton Side Branch Stent
Intervention Type
Device
Intervention Name(s)
POBA
Intervention Description
Balloon angioplasty
Primary Outcome Measure Information:
Title
Target Vessel Failure (TVF)
Time Frame
9 months
Secondary Outcome Measure Information:
Title
In-segment % diameter stenosis of the Tryton SB compared to side branch balloon angioplasty
Time Frame
9 months
Other Pre-specified Outcome Measures:
Title
Periprocedural MI after PCI, CK-MB elevation with value >3X times the upper range limit within the first 48 hrs after PCI
Description
Extended Access Registry is the extension of the Prospective multicenter, randomized, controlled study designed to enroll up to 133 subjects treated with the tryton Side Branch Stent with main branch approved DES for treatment of native coronary artery bifurcation disease in lesions >/= 2.5mm RVD
Time Frame
48 hours post PCI
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
90 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria:
The patient must be ≥18 and ≤ 90 years of age;
Symptomatic ischemic heart disease (CCS class 1-4, Braunwald Class IB, IC, IIB, IIC, IIIB, IIIC, and/or have objective evidence of myocardial ischemia);
Acceptable candidate for CABG;
Intent to treat the side branch of the target bifurcation based on angiographic evaluation;
The patient is willing to comply with specified follow-up evaluations;
The patient or legally authorized representative has been informed of the nature of the study, agrees to its provisions and has been provided written informed consent, approved by the appropriate Medical Ethics Committee (MEC) or Institutional Review Board (IRB).
Planned use of one of the following approved and commercially available drug-eluting stents for subject's index procedure: CYPHER®, ENDEAVOR® RESOLUTE, PROMUS® or PROMUS® ELEMENT, XIENCE™ V or XIENCE PRIME.
General Exclusion Criteria
Pregnant or nursing patients and those who plan pregnancy in the period up to 1 year following index procedure. Female patients of child-bearing potential must have a negative pregnancy test done within 7 days prior to the index procedure per site standard test;
Patient has had a known diagnosis of STEMI acute myocardial infarction (AMI) within 72 hours preceding the index procedure or >72 hours preceding the index procedure and CK and CK-MB have not returned to within normal limits at the time of procedure;
Patients with non-STEMI within 7 days prior to index procedure with continued CK-MB elevation;
Patients with non-target lesion PCI within 7 days prior to index procedure with continued CK-MB elevation;
Impaired renal function (serum creatinine >2.5 mg/dL or 221 μmol/l) or on dialysis;
Platelet count <100,000 cells/mm3 or >700,000 cells/mm3 or a WBC <3,000 cells/mm3;
Patient has a history of bleeding diathesis or coagulopathy or patients in whom anti-platelet and/or anticoagulant therapy is contraindicated, or any other significant medical condition which in the Investigator's opinion may interfere with the patient's optimal participation in the study;
Patient has received an organ transplant or is on a waiting list for any organ transplant;
Patient has other medical illness (e.g., cancer, known malignancy, or congestive heart failure) or known history of substance abuse (alcohol, cocaine, heroin etc.) that may cause non-compliance with the protocol, confound the data interpretation or is associated with a limited life expectancy (i.e., less than 1 year);
Patient has a known hypersensitivity or contraindication to aspirin, heparin/bivalirudin, clopidogrel/ticlopidine, prasugrel, stainless steel alloy, cobalt-chromium alloy, rapamycin, everolimus, zotarolimus, paclitaxel, and/or contrast sensitivity that cannot be adequately pre-medicated;
Patient presents with cardiogenic shock or cardiac arrhythmias that create hemodynamic instability;
Patient in whom a surgical or other procedure is planned within the next year which would require discontinuation of dual antiplatelet therapy;
Currently participating in another investigational drug or device study or patient inclusion in another investigational drug or device study where the primary endpoint of the study has not been reached.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Martin B. Leon, M.D.
Organizational Affiliation
Columbia University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Jeffery Moses
City
New York City
State/Province
New York
ZIP/Postal Code
10032
Country
United States
12. IPD Sharing Statement
Plan to Share IPD
Undecided
Citations:
PubMed Identifier
28836339
Citation
Grundeken MJ, Collet C, Ishibashi Y, Genereux P, Muramatsu T, LaSalle L, Kaplan AV, Wykrzykowska JJ, Morel MA, Tijssen JG, de Winter RJ, Onuma Y, Leon MB, Serruys PW. Visual estimation versus different quantitative coronary angiography methods to assess lesion severity in bifurcation lesions. Catheter Cardiovasc Interv. 2018 Jun;91(7):1263-1270. doi: 10.1002/ccd.27243. Epub 2017 Aug 24.
Results Reference
derived
PubMed Identifier
25914327
Citation
Muramatsu T, Grundeken MJ, Ishibashi Y, Nakatani S, Girasis C, Campos CM, Morel MA, Jonker H, de Winter RJ, Wykrzykowska JJ, Garcia-Garcia HM, Leon MB, Serruys PW, Onuma Y; TRYTON Pivotal IDE Coronary Bifurcation Trial Investigators. Comparison between two- and three-dimensional quantitative coronary angiography bifurcation analyses for the assessment of bifurcation lesions: A subanalysis of the TRYTON pivotal IDE coronary bifurcation trial. Catheter Cardiovasc Interv. 2015 Sep;86(3):E140-9. doi: 10.1002/ccd.25925. Epub 2015 Apr 24.
Results Reference
derived
PubMed Identifier
25700754
Citation
Grundeken MJ, Ishibashi Y, Genereux P, LaSalle L, Iqbal J, Wykrzykowska JJ, Morel MA, Tijssen JG, de Winter RJ, Girasis C, Garcia-Garcia HM, Onuma Y, Leon MB, Serruys PW. Inter-core lab variability in analyzing quantitative coronary angiography for bifurcation lesions: a post-hoc analysis of a randomized trial. JACC Cardiovasc Interv. 2015 Feb;8(2):305-314. doi: 10.1016/j.jcin.2014.12.002.
Results Reference
derived
PubMed Identifier
25677311
Citation
Genereux P, Kumsars I, Lesiak M, Kini A, Fontos G, Slagboom T, Ungi I, Metzger DC, Wykrzykowska JJ, Stella PR, Bartorelli AL, Fearon WF, Lefevre T, Feldman RL, LaSalle L, Francese DP, Onuma Y, Grundeken MJ, Garcia-Garcia HM, Laak LL, Cutlip DE, Kaplan AV, Serruys PW, Leon MB. A randomized trial of a dedicated bifurcation stent versus provisional stenting in the treatment of coronary bifurcation lesions. J Am Coll Cardiol. 2015 Feb 17;65(6):533-43. doi: 10.1016/j.jacc.2014.11.031.
Results Reference
derived
Links:
URL
http://www.trytonmedical.com
Description
Sponsor website
Learn more about this trial
Prospective, Single Blind, Rand Controlled Study to Evaluate the Safety & Effectness of Tryton Side Branch Stent Used With DES Treatmt of de Novo Bifurcation Lesions in MB & SB in Native Coronaries
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