Direct coronary stenting compared with stenting after predilatation is feasible, safe, and more cost-effective in selected patients: evidence to date indicating similar late outcomes

Abstract

Direct stenting compared with stenting with predilatation is feasible, safe, faster and more cost-effective. The evidence to date shows similar late outcomes.

The independent value of a direct stenting strategy on early and late clinical outcomes in patients undergoing elective percutaneous coronary intervention

“…Our findings regarding procedural time, contrast use, and the implicit decrease in the number of balloons utilized are consistent with previous reports that conclude that DS achieves a reduction in procedural and radiation exposure times [1,7,9], as well as overall costs determined by a decrease in resource utilization [4,36,37].…”

The SIRIUS‐DIRECT trial: A multi‐center study of direct stenting using the sirolimus‐eluting stent in patients with de novo native coronary artery lesions

“…Direct stenting (stent deployment without balloon predilatation) was practiced with increasing frequency during the bare‐metal stent era in an attempt to reduce both restenosis and resource consumption. While randomized trials comparing direct stenting with conventional predilatation techniques failed to demonstrate a significant reduction in restenosis [1–5], direct stenting has become widespread due to decreased procedure time, X‐ray exposure, resource consumption (equipment and contrast), and overall procedure expense [1, 2, 6–16].…”

Interventional cardiology in Israel at 2005—state of practice

“…Use of cost-effective devices: The 'Working Group of Interventional Cardiology of the Israel Heart Society' took it upon themselves to examine in 'registry style' new coronary devices. Most sites have used stents almost exclusively (3) with conservative pre-stenting 'lesion interrogation' or 'lesion preparation' (limited to balloon or cutting balloon angioplasty), or when appropriate performed cost-saving 'direct stenting' (4,5). The group also formed the guidelines for the use for DES, with the consensus that these costly devices should be deployed selectively (6), for certain patient and lesion subsets (7,8).…”