1. J Hermiller MD 1 Bifurcation Lesion Treatment Option: Insights From Clinical Literature James Hermiller, MD, FACC, FSCAI St Vincent Medical Group St Vincent Heart Center of Indiana Indianapolis, IN Presentation Theater: Tryton Pivotal: Randomized Trial and Confirmatory Study – Implications for Everyday Practice Tuesday, October 13, 2015 11:53 AM - 12:02 PM Room: Moscone South, Exhibit Hall, Presentation Theater 4 Presentation Theater Programs

2. J Hermiller MD 2 Disclosure Statement of Financial Interest Grant/Research Support Consulting Fees/Honoraria Edwards, 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

3. J Hermiller MD 3 Key Points Bifurcation Lesions: Continues to be a problem – we don’t have the right tools

4. J Hermiller MD 4 Key Points Bifurcation Lesions: Continues to be problem Only Lesion Subset Not Routinely Stented Combined Literature: Supports Provisional over 2 Stent Strategies Study Population Primarily Focused on Small SB – BBC 1 – Nordic 1 Studies with Large SB Favors 2 Stent Approach – DK Crush – 2 Stent ‘Simple’ Dedicated Stent Dedicated Side Branch Stent: Focused on Providing Straight Forward 2 stent solution

5. J Hermiller MD 5 Bifurcation Lesions are Common

6. J Hermiller MD 6 Bifurcation Lesions Yield Complications Thrombosis Rate – Incidence: 3.6-3.9% – Hazard Ratio: 4.6-6.5 Restenosis Rates – Angiographic 20-40%

7. J Hermiller MD 7 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. Lefèvre, France Courtesy of Dr. Schulze, Germany Courtesy of Dr. M. Lesiak, Poland Courtesy of Drs. E. Grübe - R. Müller, Germany

8. J Hermiller MD 8 Multiple Treatment Strategies Implementation: High Variability/Poorly Characterized

9. J Hermiller MD 9

10. J Hermiller MD 10 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) SB <2.5 mm: 1-stent SB ≥2.5 mm: 2-stent SB <2.5 mm: 1-stent SB ≥2.5 mm: 2-stent

11. J Hermiller MD 11 Studies Involving Large Side Branches Favor 2- stent Strategy

12. J Hermiller MD 12 Tryton: Dedicated 2 Stent Approach BaselineTrytonFinal

13. J Hermiller MD 13 Key Points Bifurcation Lesions: Continues to be problem Only Lesion Subset Not Routinely Stented Combined Literature: Supports Provisional over 2 Stent Strategies Study Population Primarily Focused on Small SB – BBC 1 – Nordic 1 Studies with Large SB Favors 2 Stent Approach – DK Crush – 2 Stent ‘Simple’ Dedicated Stent Dedicated Side Branch Stent: Focused on Providing Straight Forward 2 stent solution

14. J Hermiller MD 14 Thank You!!!!!! Herms2@gmail.com