OBJECTIVES Coronary stenting is the primary therapeutic option for percutan
eous treatment of many coronary lesions, after the risk of subacute stent t
hrombosis and bleeding complications has been reduced by improved antithrom
botic regimens and high pressure stent expansion.
BACKGROUND Direct stent implantation (without predilation) has been conside
red 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 c
onsidered candidates for direct stent implantation without predilation, acc
ording to prespecified criteria (i.e., absence of severe coronary calcifica
tions 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) o
n 123 lesions. The impact of direct stenting in terms of cost, procedure ti
me, 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 s
ubacute complications occurred in these patients. Procedure time, radiation
exposure time and cost were significantly lower in the group of patients w
ho 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 t
o be a safe and successful procedure that provides a way to contain cost an
d to shorten radiation exposure time. (C) 1999 by the American College of C
ardiology.