Direct coronary stenting: Effect on coronary blood flow, immediate and late clinical results

Direct stenting (DS) was attempted in 99 coronary lesions in 94 patients wh ile standard stenting (SS) was attempted in 113 lesions in 103 patients mat ched for clinical characteristics, stenosis type, and location and stent ty pe. The angiographic result was also evaluated according to TIMI frame coun t method (TFC) before and after procedure. A clinical follow-up was perform ed 1 year after the procedure. Before the procedure, TIMI grade 3 flow was detected in 42 cases (42.4%), grade 2 in 40 cases (40.4%), grade 1 in 5 cas es (5.1 %), and grade 0 in 12 cases (12.1 %) in the DS group; these data we re similar in SS group. After the procedure, TIMI grade flow was 3 in 90 ca ses (92.8%) in DS group and in 87 (77.0%) in SS group (P < 0.005); grade 2 was observed in 7 case (7.2%) in DS group and in 25 (22.1 %) in SS group (P < 0.005). Major adverse cardiac events during hospitalization and at follo w-up were similar in two groups. Radiation exposure time and procedure cost s per lesion were significantly reduced in DS group compared to SS group (1 0.1 8 min vs. 13.9 4.7 min, P < 0.001; and 1901 +/- 687 Euro vs. 2352 +/- 7 43 Euro, P < 0.001, respectively). This study confirms that, in selected pa tients, direct stenting is a safe and successful procedure, allowing a sign ificant reduction in radiation exposure time and procedural costs compared to standard stenting technique. The angiographic success is confirmed by th e improvement in TFC in all cases. (C) Wiley-Liss, Inc.