Biomechanical Impact of Wrong Positioning of a Dedicated Stent for Coronary Bifurcations: A Virtual Bench Testing Study

The treatment of coronary bifurcations is challenging for interventional cardiologists. The Tryton stent (Tryton Medical, Inc., USA) is one of the few devices specifically designed for coronary bifurcations that underwent large clinical trials. Although the manufacturer provides specific recommendations to position the stent in the bifurcation side branch (SB) according to four radio-opaque markers under angiographic guidance, wrong device positioning may accidentally occur. In this study, the virtual bench testing approach was used to investigate the impact of wrong positioning of the Tryton stent in coronary bifurcations in terms of geometrical and biomechanical criteria. A finite element model of the left anterior descending/first diagonal coronary bifurcation was created with a 45° distal angle and realistic lumen diameters. A validated model of the Tryton stent mounted on stepped delivery balloon was used. All steps of the Tryton deployment sequence were simulated. Three Tryton positions, namely ‘proximal’, ‘recommended’, and ‘distal’ positions, obtained by progressively implanting the stent more distally in the SB, were compared. The ‘recommended’ case exhibited the lowest ostial area stenosis (44.8 vs. 74.3% (‘proximal’) and 51.5% (‘distal’)), the highest diameter at the SB ostium (2.81 vs. 2.70 mm (‘proximal’) and 2.54 mm (‘distal’)), low stent malapposition (9.9 vs. 16.3% (‘proximal’) and 8.5% (‘distal’)), and the lowest peak wall stress (0.37 vs. 2.20 MPa (‘proximal’) and 0.71 MPa (‘distal’)). In conclusion, the study shows that a ‘recommended’ Tryton stent positioning may be required for optimal clinical results.