Direct coronary stenting versus predilatation followed by stent placement

• Published in: The American journal of cardiology 2002-12, Vol.90 (11), p.1187-1192
• Main Authors: Brueck, Martin, Scheinert, Dierk, Wortmann, Alois, Bremer, Jens, von Korn, Hubertus, Klinghammer, Lutz, Kramer, Wilfried, Flachskampf, Frank A, Daniel, Werner G, Ludwig, Josef
• Format: Article
• Language: English
• Subjects: Aged; Angioplasty, Balloon, Coronary; Benefit cost analysis; Biological and medical sciences; Cardiology; Clinical outcomes; Coronary Angiography; Coronary Stenosis - therapy; Cost-Benefit Analysis; Diseases of the cardiovascular system; Female; Follow-Up Studies; Humans; Male; Medical sciences; Methods; Middle Aged; Prospective Studies; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Risk Factors; Stents; Treatment Outcome
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/S0002-9149(02)02832-1

Direct stenting without antecedent dilatation may reduce procedural time, costs, and radiation exposure, and may result in less vessel injury. The purpose of this investigation was to compare immediate and long-term clinical and angiographic outcomes of direct stenting with stent placement after initial balloon dilation. Three hundred thirty-five symptomatic patients with single or multiple coronary lesions (diameter reduction 60% to 95%) of ≤30 mm length and with a vessel diameter of 2.5 to 4.0 mm were randomized either to direct stenting (group A, n = 171) or stenting after predilation (group B, n = 164). Patients with vessels with excessive calcification, severe proximal tortuosity, or occlusion were excluded. All patients were asked to return for routine repeat angiography at 6 months, irrespective of symptoms. Feasibility of direct stenting was 95% in group A, with 5% requiring crossover to predilation. Successful stent placement after predilation was performed in all 164 patients in group B. Direct stenting was associated with less procedural duration (group A 42.1 ± 18.7 minutes vs group B 51.5 ± 23.8 minutes, p = 0.004), radiation exposure time (group A 10.3 ± 7.7 minutes vs group B 12.5 ± 6.4 minutes, p = 0.002), amount of contrast dye used (group A 163 ± 69 ml vs group B 197 ± 84 ml, p