Coronary stenting without predilatation in broad spectrum of clinical and angiographic situations

Background Direct coronary stenting without balloon predilatation has the p otential benefits of a reduced risk of extended dissections, reduced fluoro scopy exposure, reduced procedural time, and potential cost savings. With t he availability of superior stents and delivery systems, we review our expe rience with direct stent deployments in a large selected patient cohort. Methods. We prospectively studied 158 consecutive cases of attempted corona ry stenting without balloon predilatation over a 1-year period. Results. Indications for the procedure included unstable angina (71%), stab le angina (24%) and acute myocardial infarction (5%). Target vessels were t he anterior descending artery (56%), right coronary artery (30%), circumfle x artery (8%), and vein grafts (6%). Pre-procedural TIMI flows were grade 3 (91.7%), grade 2 (5.8%), grade 1 (1.3%) and 0 (1.3%). Lesion types were gr aded A (27%), B (61%), and C (12%). Stent types included NIR Prime (80.4%), ACS Multi-link RX Duet (10.1%), NTR (5.1%), and others (4.4%). Stents rang ed from 3.0-4.0 mm in diameter (median = 3 mm) and 8-32 mm in length (media n = 16 mm). Stents were successfully deployed in 155 cases (98.1%); 2 (1.3% ) required predilatation and 1 (0.6%) deployed stent could not be expanded and was opened by rotablation. All except the rotablator case achieved fina l TIMI grade 3 flow, and 66% did not require further balloon dilatation. Th ere were no deaths or cases of urgent bypass surgery. Case duration and rad iation exposure in direct stenting (32.8 +/- 18.9 minutes and 6.7 +/- 6.2 m inutes, respectively) compared favorably to those in a matched group of pat ients in conventional stenting (47 +/- 18 minutes and 11 +/- 7 minutes) and coronary angioplasty (40 +/- 12 minutes and 10 +/- 6 minutes) for single-l esion cases (p < 0.005). Creatine kinase elevation related to the procedure was observed in 5 patients. Subacute stent thrombosis occurred in 2 (1.3%) cases. Conclusions. Direct coronary stenting was successfully and safely accomplis hed in a variety of clinical situations in selected patients.