This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Briguori, C. Articles by Colombo, A. Search for Related Content PubMed PubMed Citation Articles by Briguori, C. Articles by Colombo, A.

CLINICAL STUDIES

Direct coronary stenting without predilation

Carlo Briguori, MD, Imad Sheiban, MD^*, Joseph De Gregorio, MD, Angelo Anzuini, MD^*, Matteo Montorfano, MD^*, Paolo Pagnotta, MD^*, Federica Marsico, MD^*, Filippo Leonardo, MD^*, Carlo Di Mario, MD, PhD^* and Antonio Colombo, MD, FACC

^* San Raffaele Hospital, Interventional Cardiology, HSR, Milan, Italy
Centro Cuore Columbus, Milan, Italy

Manuscript received March 2, 1999; revised manuscript received June 21, 1999, accepted August 25, 1999.

Reprint requests and correspondence: Dr. Imad Sheiban, San Raffaele Hospital, HRS, Via Olgettina, 60, I-20142, Milan, Italy
imadsheiban{at}hsr.it

OBJECTIVES

Coronary stenting is the primary therapeutic option for percutaneous treatment of many coronary lesions, after the risk of subacute stent thrombosis and bleeding complications has been reduced by improved antithrombotic regimens and high pressure stent expansion.

BACKGROUND

Direct stent implantation (without predilation) has been considered a promising new technique that may reduce the procedure time, radiation exposure time and cost.

METHODS

After having reviewed all cases of stent implantation from February to June 1998 (n = 585), 185 (32%) of these patients were retrospectively considered candidates for direct stent implantation without predilation, according to prespecified criteria (i.e., absence of severe coronary calcifications and/or tortuosity of the lesion or the segment proximal to the lesion). By operator preference, direct coronary stent implantation was actually attempted in 123 (21%) of the 585 patients (100 men, 60 ± 10 years old) on 123 lesions. The impact of direct stenting in terms of cost, procedure time, radiation exposure time and amount of contrast dye used was assessed by comparing the two groups of patients who underwent single-vessel stenting without (n = 69) and with (n = 46) predilation.

RESULTS

Direct stenting was successful in 118 patients (96%). No acute or subacute complications occurred in these patients. Procedure time, radiation exposure time and cost were significantly lower in the group of patients who had single-vessel direct versus conventional stenting (45 ± 31 vs. 64 ± 46 min, 12 ± 9 vs. 16 ± 10 min and 1,305 ± 363 vs. 2,210 ± 803 Euro, respectively; p < 0.05 for all).

CONCLUSIONS

Direct stenting without predilation in selected lesions seems to be a safe and successful procedure that provides a way to contain cost and to shorten radiation exposure time.

Abbreviations and Acronyms   MACE = major adverse cardiac events   PTCA = percutaneous transluminal coronary angioplasty

This article has been cited by other articles:

				T. Cuisset, M. Hamilos, N. Melikian, E. Wyffels, J. Sarma, G. Sarno, E. Barbato, J. Bartunek, W. Wijns, and B. De Bruyne Direct stenting for stable angina pectoris is associated with reduced periprocedural microcirculatory injury compared with stenting after pre-dilation. J. Am. Coll. Cardiol., March 18, 2008; 51(11): 1060 - 1065. [Abstract] [Full Text] [PDF]

				E. Okmen, N. Cam, A. Sanli, S. Unal, Z. Tartan, and M. Vural Cardiac Troponin I Increase After Successful Percutaneous Coronary Angioplasty: Predictors and Long-Term Prognostic Value Angiology, March 1, 2006; 57(2): 161 - 169. [Abstract] [PDF]

				W. Wijns, S. Verheye, G. Manoharan, G. S. Werner, E. Grube, B. De Bruyne, J. Koolen, C. W. Hamm, A. Medina, J. W. Bech, et al. Angiographic, intravascular ultrasound, and fractional flow reserve evaluation of direct stenting vs. conventional stenting using BeStent2 in a multicentre randomized trial Eur. Heart J., September 2, 2005; 26(18): 1852 - 1859. [Abstract] [Full Text] [PDF]

				M Herzum, R Cosmeleata, and B Maisch Managing a complication after direct stenting: removal of a maldeployed stent with rotational atherectomy Heart, June 1, 2005; 91(6): e46 - e46. [Abstract] [Full Text] [PDF]

				Y. Atmaca, C. Ozdol, F. Ertas, T. Altin, S. Gulec, and D. Oral Effect of Direct Stent Implantation on QTc Dispersion Angiology, March 1, 2005; 56(2): 143 - 149. [Abstract] [PDF]

				E. Okmen, N. Cam, A. Sanli, F. Yapici, H. Uyarel, M. Vural, and R. Ozturk Effects of Direct Stent Implantation and Conventional Stent Implantation on Minor Myocardial Injury Angiology, September 1, 2004; 55(5): 485 - 491. [Abstract] [PDF]

				E. Barbato, J. Marco, and W. Wijns Direct stenting Eur. Heart J., March 1, 2003; 24(5): 394 - 403. [Abstract] [Full Text] [PDF]

				A.J.J IJsselmuiden, P.W Serruys, A Scholte, F Kiemeneij, T Slagboom, L.R v/d Wieken, G.J Tangelder, and G.J Laarman Direct coronary stent implantation does not reduce the incidence of in-stent restenosis or major adverse cardiac events: Six month results of a randomized trial Eur. Heart J., March 1, 2003; 24(5): 421 - 429. [Abstract] [Full Text] [PDF]

				S Miketic, J Carlsson, and U Tebbe Clinical and angiographic outcome after conventional angioplasty with optional stent implantation compared with direct stenting without predilatation Heart, December 1, 2002; 88(6): 622 - 626. [Abstract] [Full Text] [PDF]

				J. G. Tejada, A. Albarran, M. T. Velazquez, J. Sanz, C. Pindado, and J. C. Tascon Direct Stenting in Single Coronary Artery Arising from the Left Sinus of Valsalva: A Case Report Angiology, November 1, 2002; 53(6): 733 - 736. [Abstract] [PDF]

				J Herrmann, C von Birgelen, M Haude, L Volbracht, N Malyar, H Eggebrecht, T F M Konorza, D Baumgart, and R Erbel Prognostic implication of cardiac troponin T increase following stent implantation Heart, June 1, 2002; 87(6): 549 - 553. [Abstract] [Full Text] [PDF]

				A. Colombo Direct stenting: safe with advantages for the patient and for the doctor (less fluoroscopy and procedural time) Eur. Heart J., April 2, 2002; 23(8): 592 - 595. [Full Text] [PDF]

				L. Martinez-Elbal, J.M. Ruiz-Nodar, J. Zueco, J.R. Lopez-Minguez, J. Moreu, I. Calvo, J.A. Ramirez, M. Alonso, N. Vazquez, R. Lezaun, et al. Direct coronary stenting versus stenting with balloon pre-dilation: immediate and follow-up results of a multicentre, prospective, randomized study. The DISCO trial Eur. Heart J., April 2, 2002; 23(8): 633 - 640. [Abstract] [Full Text] [PDF]

				C. Loubeyre, M.-C. Morice, T. Lefevre, J.-F. Piechaud, Y. Louvard, and P. Dumas A randomized comparison of direct stenting with conventional stent implantation in selected patients with acute myocardial infarction J. Am. Coll. Cardiol., January 2, 2002; 39(1): 15 - 21. [Abstract] [Full Text] [PDF]

				H Le Breton, J Boschat, P Commeau, P Brunel, M Gilard, C Breut, O Bar, P Geslin, A Tirouvanziam, L Maillard, et al. Randomised comparison of coronary stenting with and without balloon predilatation in selected patients Heart, September 1, 2001; 86(3): 302 - 308. [Abstract] [Full Text] [PDF]

				C. Di Mario, J. W. Moses, T. J. Anderson, R. Bonan, T. Muramatsu, A. C. Jain, J. Suarez de Lezo, S. Y. Cho, M. Kern, I. T. Meredith, et al. Randomized Comparison of Elective Stent Implantation and Coronary Balloon Angioplasty Guided by Online Quantitative Angiography and Intracoronary Doppler Circulation, December 12, 2000; 102(24): 2938 - 2944. [Abstract] [Full Text] [PDF]

				P.N. Ruygrok and M.W.I. Webster Provisional vs primary stenting during percutaneous coronary intervention Eur. Heart J., September 2, 2000; 21(18): 1557 - 1557. [PDF]