title: [Nonselected use of direct coronary stenting. The DISCO 2 trial].
abstract: OBJECTIVE
  Direct coronary stenting yields immediate long-term clinical results similar to those obtained with balloon predilation, with the advantage of lower costs and procedural times. Until now, direct stenting has been attempted only for selected lesions, so that the potential scope of its use in everyday practice remains unknown. The DISCO 2 trial was designed to identify the number and type of lesions that could be safely treated by direct stenting. Patients and method. 1,269 lesions (886 patients) were treated consecutively in 7 different hospitals. Direct stenting was attempted in all cases, except for total chronic occlusions, severe tortuosity or calcification of the vessel, lesions in the sinus ostium, or bifurcated lesions and vessel diameter < 2.4 mm. If the procedure failed, the stent was recovered and the lesion dilated with a balloon before a second attempt at stenting.
  
  
  RESULTS
  Direct stenting was attempted in 585 lesions (54.9% of all electively implanted stents and 46.1% of all angioplasties). This was successful in 553 (94.6%) and failed in 32 (5.4%). In 30 of these latter patients a stent was implanted after predilation. Predictors of failure were tortuosity, location in the nonproximal right coronary artery, age > 65 years and type B2 or C lesion. After 6 months of follow-up the total incidence of major adverse cardiovascular events in patients treated with direct stenting was 6.2%, with a target lesion revascularization rate of 4.45%.
  
  
  CONCLUSIONS
  In a mostly nonselected sample of coronary lesions, direct stenting was as safe as stenting with predilation. More than half of all elective stenting procedures can be attempted safely without balloon predilation. Greater need for predilation was associated with tortuosity, nonproximal right coronary artery location, older age and lesion complexity (B2, C). The 6-month clinical outcome was excellent, with a low rate of repeat revascularization.
authors.affiliation: Servicio de Cardiología. Hospital Universitario de La Princesa. Madrid. España.
authors.forename: Luis
authors.initials: L
authors.lastname: Martínez Elbal
authors.forename: Susana
authors.initials: S
authors.lastname: Mingo
authors.forename: Javier
authors.initials: J
authors.lastname: Zueco
authors.forename: Isabel
authors.initials: I
authors.lastname: Calvo
authors.forename: José
authors.initials: J
authors.lastname: Moreu
authors.forename: Antonio
authors.initials: A
authors.lastname: Merchán
authors.forename: Rafael
authors.initials: R
authors.lastname: Melgares
authors.forename: Felipe
authors.initials: F
authors.lastname: Fernández Vázquez
mesh_terms: D017130:Angioplasty; D023921:Coronary Stenosis / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents