M. Hoffmann et al., Direct coronary stent implantation without predilatation - a new therapeutic approach with a special balloon catheter design, Z KARDIOL, 88(2), 1999, pp. 123-132
Citations number
34
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Stent implantation serves as the gold standard for proximal lesions of the
coronary arteries with a diameter between 2.75-3.5 mm. Our new concept aims
at a reduced procedure duration and fluoro-time as well as a decreased isc
hemic period during stent implantation.
A new therapeutic concept of a direct stent implantation without predilatat
ion was tested using a specially developed balloon catheter on which variou
s 14-16 mm long "slotted-tube" stents are mounted between two conical, radi
opaque markers. In 105 consecutive patients, who were scheduled for angiopl
asty, this method of direct stent implantation was performed. Six of the pr
ocedures were performed for acute myocardial infarction and 8 in socalled h
igh-risk procedures. The direct stent implantation was successful in 88%. I
n 6%, predilatation of the lesion site was necessary before stent placement
. In the remaining 6%, a stent could not be successfully implanted despite
the availability of various other systems.
Comparison of the direct stent implantation with conventional stent placeme
nt with predilatation revealed that 1) The fluoro-time for direct stent imp
lantation, compared to the conventional method, was 8.4 +/- 4.9 min vs. 13.
7 +/- 8.0 min; p < 0.05, respectively Furthermore, there were less balloons
used per lesion for direct stent implantation (1.4 +/- 0.4) compared to th
e conventional method (1.7 +/- 0.7), but there was not a significant differ
ence. 2) If we compare those patients with successful direct stent implanta
tion with those with the unsuccessful procedures, the latter group had a hi
gher percent of angiographically visible calcification at the site of the l
esion (80% vs. 18%; p < 0.01). In addition, these patients had an increased
average age (72 +/- 7 vs. 61 +/- 11 yrs; p < 0.01). The success rate of di
rect stent implantation did not depend on lesion diameter stenosis before P
TCA.
Stent dislocation was observed in 3.8% of the procedures, and a single case
of stent embolism was seen.
In conclusion, the direct stent implantation offers the advantages of a sho
rtened fluoro-time, the use of fewer balloons, and has the potential of les
s ischemic stress compared to the conventional method of stent implantation
with predilatation, if old patients with calcified lesions are excluded. T
his should be proved on a large scale in future studies also considering a
learning curve with regard to the new method. Whether this new approach als
o reduces the restenosis rate, warrants further studies.