Feasibility, safety, cost-effectiveness and 1 year follow-up of coronary stenting without predilation: a matched comparison with the standard approach.
BACKGROUND
We evaluated the feasibility, safety, procedural cost-effectiveness, radiation dose and time and 1-year target vessel revascularization rate of direct unprotected mounted stenting without previous balloon dilatation (DS) in native coronary artery lesions.


METHODS
DS was attempted in 119 patients; 39 had a recent myocardial infarction, 62 had unstable angina, and 18 had stable angina. The clinical follow-up was obtained at 14+/-5 months (range 6 to 24 months). These results were compared with those for a consecutive group of 160 patients matched for type and length of lesions and who had a stent only if the post-balloon residual stenosis was >30%.


RESULTS
The feasibility of DS was 112/119 (94%). The number of inflations, the length of the stent/length of the lesion ratio, the time and the dose of radiation were dramatically lower in the DS group (P<0.001). DS conferred a slight reduction in procedure-related cost [$820+/-157 for DS vs. 894+/-427 for standard dilatation (SD) per patient]. The 1-year target vessel revascularization rate was similar in both groups [nine (8%) for DS vs. 17 (11%) patients for SD, ns].


CONCLUSIONS
DS is feasible and safe in selected coronary lesions. This method provides a low rate of repeat revascularization and reduces the time and the dose of radiation compared with the standard approach.
Larrazet
F
F
Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75674 Paris Cedex 14, France. fabrice.larrazet@imm.fr
Philippe
F
F
Caussin
C
C
Lancelin
B
B
Aptecar
E
E
Pernes
J M
JM
Laborde
F
F
Dibie
A
A
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000191:economics; D023903:Coronary Restenosis / Q000517:prevention & control*; D023921:Coronary Stenosis / Q000191:economics / Q000628:therapy*; D003362:Cost-Benefit Analysis; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents / Q000009:adverse effects / Q000191:economics; D013997:Time Factors; D016896:Treatment Outcome