Direct coronary stenting in reducing radiation and radiocontrast consumption

Abstract

IntroductionCoronary stenting is the primary means of coronary revascularization. There are two basic techniques of stent implantation: stenting with balloon predilatation of stenosis and stenting without predilatation (direct stenting). Limiting the time that a fluoroscope is activated and by appropriately managing the intensity of the applied radiation, the operator limits radiation in the environment, and this saves the exposure to the patient and all personnel in the room. Nephrotoxicity is one of the most important properties of radiocontrast. The smaller amount of radiocontrast used also provides multiple positive effects, primarily regarding the periprocedural risk for the patients with the reduced renal function. The goal of the study was to compare fluoroscopy time, the amount of radiocontrast, and expenses of material used in direct stenting and in stenting with predilatation.Patients and methodsIn a prospective study, 70 patients with coronary disease were randomized to direct stenting, or stenting with predilatation.ResultsFluoroscopy time and radiocontrast use were significantly reduced in the directly stented patients in comparison to the patients stented with balloon-predilatation. The study showed a significant reduction of expenses when using a direct stenting method in comparison to stenting with predilatation.ConslusionsIf the operator predicts that the procedure can be performed using direct stenting, he is encouraged to do so. Direct stenting is recommended for all percutaneous coronary interventions when appropriate conditions have been met. If direct stenting has been unsuccessful, the procedure can be converted to predilatation.

Direct implantation of rapamycin-eluting stents with bioresorbable drug carrier technology utilising the Svelte coronary stent-on-a-wire: the DIRECT II study

“…In DIRECT II, the transradial approach was used in two thirds of cases with a high rate of procedural success. TRI, which is already prevalent in Europe, is steadily growing within the United States, given its association with reduced access-site complications, e 621 Stent-on-a-wire coronary DES shorter procedure and patient ambulation times and enhanced patient comfort 6,[14][15][16][17][18] . However, reducing device profiles remains a priority given the increased incidence of procedural complications, including radial artery occlusion, with larger catheter sizes.…”

“…Downsizing catheters facilitates transradial intervention (TRI) in more patients, reducing the risk of bleeding complications, morbidity and mortality 1 , especially in ACS patients 2,3 , while improving time to ambulation, patient comfort and time and cost of PCI 4,5 . Direct stenting streamlines stent delivery and conveys important patient benefits, including reduced radiation exposure and intervention time 6 , myocardial infarction (MI) and death 7 , compared with conventional stenting in suitable lesions 8 . It also reduces the potential for mismatch between the section of the artery predilated and the section actually stented, a relevant consideration for long-term safety.…”

Radiation Principles and Safety

“…Complex procedures, such as multivessel interventions, treating chronic total occlusions, or bifurcation lesions demand more procedure time than the simple interventions, and this leads to increased radiation dose when treating more complex coronary disease [16]. Some practical advices: when documenting balloon inflation, just a short single shot should be enough, there is no need to prolong the shot of an inflated balloon; there is no reason to record or observe the gradual balloon deflation, this can be checked with short beam-on shots; the operator's foot should be kept away from the fluoropedal when not actually using fluorography, as to not accidentally step on the pedal and produce unnecessary radiation; a diagnostic fluorography can in most cases (but not always) be limited to a single cardiac cyclus; direct stenting can also be used and is proven to reduce beam-on time [17,18].…”

Impact of direct stenting on clinical outcomes for small vessel coronary artery disease in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction

“…Pre-dilation may induce intimal dissection necessitating multiple or altogether longer stents, increasing the risk of restenosis [7]. DS also offers significant reductions in procedure time, radiation exposure, contrast administration, and adjunctive material, use and also cost reduction was achieved by direct stenting [8]. However, a number of disadvantages have been suggested for DS, including failure to cross the lesion, incomplete stent deployment, an increase in guide trauma, undersizing the stent, and poor visualization, which may result in errors in stent positioning [9].…”