Direct coronary stenting without balloon predilation in acute coronary syndromes

Background This prospective, observational study was designed to evaluate t he feasibility and the safety of a new strategy for stenting in acute coron ary syndromes: direct stent implantation without predilation of the culprit lesion. This strategy might reduce both the cost of the procedure and the rate of no-reflow, a phenomenon that is more frequently observed during dil ation of unstable plaques. Methods and Results Between September 1997 and March 1998, 122 carefully se lected patients with unstable angina or acute myocardial infarction were in cluded in this study. Highly calcified lesions and vessels with excessive p roximal tortuosity were excluded. The procedure was successful in 96% of ca ses. In 5 cases the stent failed to pass through the stenosis and was succe ssfully retrieved in the guiding catheter in 3 cases. In 2 cases the stent was lost in the peripheral circulation. Transient no-reflow occurred in onl y 3 cases and was rapidly reversed by rescue use of an intracoronary bolus injection of a glycoprotein IIb/IIIa receptor inhibitor in 2 cases. A patie nt treated by primary angioplasty with cardiogenic shock on admission died 48 hours after the initial procedure because of irreversible cardiac failur e. One-month clinical follow-up was obtained by telephone for all patients; no major coronary events occurred during this period. Conclusions Direct coronary stenting without balloon predilation can be saf ely performed in acute coronary syndrome-related lesions in selected patien ts. A randomized, controlled study is warranted to confirm the promising re sults of this pilot study, especially regarding the low rate of the no-refl ow phenomenon.