title: Is direct stent implantation without predilatation safe? Acute and long-term outcome.
abstract: Direct stenting could potentially lead to a reduction in dissections, time, and restenosis at 6-month follow-up. Using the premounted Palmaz-Schatz Crown stent elective stenting was performed without predilatation in 61 consecutive patients who were compared with a control group of provisional stenting. All patients underwent clinical and angiographic follow-up at 6 months. Direct stenting was successful in 81% of patients. In 16% of the patients predilatation was needed. In 3% the stent could not be implanted despite predilatation. Stent dislodgment occurred in 2% of patients, without embolization. Six-month angiographic follow-up was performed in 51 (84%) of 61 patients. In the direct stenting group the mean preprocedural minimal luminal diameter (MLD) increased from 0.96 +/- 0.47 to 3.09 +/- 0.54 mm directly after the procedure. At 6-month follow-up the MLD measured 2.32 +/- 0.79 mm. In the provisional stenting group the mean MLD increased from 0.92 +/- 0.51 to 2.44 +/- 0.58 mm and was 1.84 +/- 0.70 mm at 6-month follow-up. Restenosis, defined as a diameter stenosis > 50%, occurred in 8% of the direct stenting group compared with 28% in the provisional stenting group (P < 0.001). Direct coronary stent implantation can be attempted safely and efficaciously. The risk of stent loss is low. The initial and long-term angiographic results are significantly better as compared with provisional stenting. The risk of restenosis is significantly lower.
authors.affiliation: Department of Interventional Cardiology, St. Antonius Hospital, P.O. Box 2500, 3430 EM Nieuwegein, The Netherlands.
authors.forename: Braim M
authors.initials: BM
authors.lastname: Rahel
authors.forename: Maarten Jan
authors.initials: MJ
authors.lastname: Suttorp
authors.forename: Jurriën M
authors.initials: JM
authors.lastname: Ten Berg
authors.forename: Egbert T
authors.initials: ET
authors.lastname: Bal
authors.forename: Sjef M P G
authors.initials: SM
authors.lastname: Ernst
authors.forename: E Gijs
authors.initials: EG
authors.lastname: Mast
authors.forename: Johannes C
authors.initials: JC
authors.lastname: Kelder
authors.forename: H W Thijs
authors.initials: HW
authors.lastname: Plokker
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000150:complications / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary; D019917:Blood Vessel Prosthesis Implantation; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D023903:Coronary Restenosis / Q000209:etiology / Q000628:therapy; D023921:Coronary Stenosis / Q000150:complications / Q000628:therapy; D003331:Coronary Vessels / Q000601:surgery; D004106:Dilatation; D004869:Equipment Safety; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome