Direct coronary stenting without predilation

Briguori, Carlo; Sheiban, Imad; Gregorio, Joseph De; Anzuini, Angelo; Montorfano, Matteo; Pagnotta, Paolo; Marsico, Federica; Leonardo, Filippo; Mario, Carlo Di; Colombo, Antonio

doi:10.1016/s0735-1097(99)00453-2

Cited by 105 publications

(77 citation statements)

References 15 publications

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“…In particular, it has been suggested that direct stenting may help to "tack up" dissection flaps as they form and thereby prevent extension. 5,[11][12][13] In our study, a relatively high incidence of dissection was observed in the conventional stent group (13% versus the direct stent group (2.5%), providing support for this concept. A relatively low incidence of side-branch loss following direct stenting has been reported and it was speculated that this result was due to a reduction in the "snow plow" effect.…”

Section: Discussionsupporting

confidence: 54%

“…In animal models, direct stenting appears to result in less endothelial denudation than dilation followed by stenting. 14,15) This has been hypothesized to result in a reduced intimal proliferative response and potentially less restenosis 5,14,15) and, one might also speculate less thrombotic potential, and less future cardiac events. The BET study showed better, but statistically insignificant, results with direct stent implantation concerning the incidence of major adverse cardiac events (5.3% vs 11.2%).…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] Direct stenting is the term applied to the technique of coronary stent implantation without first preparing the way with balloon predilation. [4][5][6] There are considerable potential advantages of direct stenting over conventional stenting with respect to savings in procedural time, contrast load, and fluoroscopy time. Because predilation is not employed, there is also an additional saving on angioplasty balloons.…”

mentioning

confidence: 99%

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Long-Term Follow-Up After Angiographically Successful Coronary Stenting Direct Stent Versus Conventional Stent Implantation

et al. 2004

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SUMMARYThe purpose of the study was to compare the impacts of angiographically successful direct stent implantation and conventional stent implantation (stent implantation following predilatation) on long-term major cardiac events.The authors prospectively studied 40 patients who had successful direct stent implantation and 46 patients who had successful conventional stent implantation. The end-point of the study was defined as the occurrence of a major cardiac event, including recurrent angina, acute myocardial infarction, death, and target vessel revascularization.The demographic and clinical characteristics of the study groups were similar, except the indication of percutaneous angioplasty, which was more frequently unstable angina in the conventional stent group (63% vs 38%, P: 0.03). Procedural minor complications were more frequent in conventional stent implantation, and there was also a positive correlation between the conventional stent implantation and procedural minor complications (r = 0.231, P: 0.03), and postprocedural troponin elevation (r = 0.221, P: 0.04). The incidences of major cardiac events including recurrent angina, acute myocardial infarction, death, death or myocardial infarction, and target vessel revascularization were not different between the study groups during the long-term follow-up period (21 ± 7.1 months for direct stent group and 20 ± 7.5 months for conventional stent group). Overall end-points occurred in 9 patients (22%) in the direct stent group and in 9 patients (19%) in the conventional stent group. Kaplan-Meier survival analysis showed that there was no difference in event-free survival between the patients treated with direct stent implantation and conventional stent implantation (log-rank: 1.52, P = 0.21). Two-vessel intervention and hypertension were found to be related with long-term major cardiac events (r = 0.214, P: 0.048, r = 0.206, P: 0.04, respectively).In addition to the procedural advantages, direct stent implantation may also provide comparable results with conventional stent implantation concerning the late cardiac events following successful percutaneous coronary angioplasty. (Jpn Heart J 2004; 45: 53-62)

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Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Long-Term Follow-Up After Angiographically Successful Coronary Stenting Direct Stent Versus Conventional Stent Implantation

et al. 2004

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“…Briguori and colleagues performed a retrospective comparison of patients undergoing direct and conventional stenting. 189 Direct stenting was successful in 94% of cases in this single-centre analysis, with no inhospital deaths, MIs or emergency bypass surgery. In the direct stenting group there were significant reductions in procedure time (by 30%), radiation exposure time (by 25%), contrast dye, balloon use and cost.…”

Section: Direct Stenting Compared With Conventional Stentingmentioning

confidence: 67%

Coronary artery stents: a rapid systematic review and economic evaluation

Hill¹,

Bagust²,

Bakhai³

et al. 2004

Health Technol Assess

144

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“…20) Direct stenting with bare metal stents has been shown to reduce procedural time, radiation exposure time, and costs. 21) This technique may be particularly attractive for implanting drug-eluting stents when considering the increased cost of these devices. Potential damage to the stent polymer is a major source of concern during implantation of drug-eluting stents without predilatation, however, there is evidence demonstrating the safety and feasibility of this technique in drug-eluting stents.…”

Section: Discussionmentioning

confidence: 99%

Direct Stenting Versus Predilatation and Stenting Technique When Using Paclitaxel-Eluting Stents

et al. 2008

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SUMMARYDirect stenting without predilatation is a well-defined, feasible method with bare metal stents. Direct stenting has also been shown to be safe and feasible with drug-eluting stents, however, there is much less evidence with this type of device when compared with bare metal stents.Three hundred and sixty-four coronary lesions in 257 consecutive patients (mean age, 57.4 ± 9.8 years; 63 women) who had undergone elective stenting either with or without predilatation via a paclitaxel-eluting stent between March 2003 and March 2006 were retrospectively analyzed. Quantitative coronary angiography analysis was compared between the two groups of procedures; stenting with predilatation and direct stenting.All procedures were uneventful. No deaths occurred during the follow-up period. Direct stenting when compared with the predilatation technique, significantly decreased both procedure time (32.1 ± 17.9 minute versus 41.2 ± 18.6 minute, P < 0.0001) and fluoroscopy time (10.6 ± 7.8 minute versus 15.5 ± 7.6 minute, P < 0.0001). There was no difference in quantitative analysis parameters of coronary angiography during follow-up or the rates of stent thrombosis and restenosis.Direct stenting seems to be as feasible and safe as conventional predilatation and stenting in selected cases. Direct stenting seems to decrease procedural time and radiation exposure without any negative effect on quantitative analysis parameters of coronary angiography with approximately a one-year follow-up period. (Int Heart J 2008; 49: 545-552)

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Direct coronary stenting without predilation

Abstract: Direct stenting without predilation in selected lesions seems to be a safe and successful procedure that provides a way to contain cost and to shorten radiation exposure time.

Cited by 105 publications

References 15 publications

Long-Term Follow-Up After Angiographically Successful Coronary Stenting Direct Stent Versus Conventional Stent Implantation

Long-Term Follow-Up After Angiographically Successful Coronary Stenting Direct Stent Versus Conventional Stent Implantation

Coronary artery stents: a rapid systematic review and economic evaluation

Direct Stenting Versus Predilatation and Stenting Technique When Using Paclitaxel-Eluting Stents

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