title: Frequency and determinants of direct stenting in routine percutaneous coronary interventions: data on 835 consecutive procedures in a single center.
abstract: BACKGROUND
  Recent studies evaluated the technique of direct coronary stenting as compared to stenting-after-predilation in selected anatomic and clinical settings. However, the impact of direct stenting in routine interventional practice remains poorly elucidated.
  
  
  METHODS
  From April 1999 to March 2001, all percutaneous coronary interventions performed at our Center were prospectively analyzed to determine the frequency of direct stenting, the success rate and the variables associated with its utilization.
  
  
  RESULTS
  1151 lesions were treated in 835 procedures. Stenting was attempted in 835/1151 lesions (72.5%), 309 (37%) with direct stenting and 526 (63%) with stenting-after-predilation. Direct stenting was successful in 300/309 (97%) and stenting-after-predilation in 515/526 (98%). The success rate of direct stenting was significantly lower in small vessels (< or = 2.75 mm) (89.2 vs 98.5%, p = 0.005). Patients treated with direct stenting were younger (63 +/- 11 vs 65 +/- 11 years, p = 0.024). Direct stenting was preferentially used in saphenous vein grafts and at the ostium of the left anterior descending coronary artery, while it was avoided in bifurcation lesions and with increasing calcium burden. Operators with a caseload > 140 interventions per year were significantly more likely to perform direct stenting than less experienced operators (p = 0.017). In direct stenting, the total contrast medium and the fluoroscopy and procedural times were all significantly (p < 0.0001) lower than those observed in case of stenting-after-predilation.
  
  
  CONCLUSIONS
  Direct coronary stenting is currently performed in about one third of the overall caseload. Variables pertaining to the operator's experience, lesion morphology and length, vessel size, and the clinical presentation are all important factors determining the selection of candidates suitable for direct stenting.
authors.affiliation: Catheterization Laboratory, Department of Cardiology, San Bortolo Hospital, Vicenza, Italy. lavecchia.cardiovi@libero.it
authors.forename: Luigi
authors.initials: L
authors.lastname: La Vecchia
authors.forename: Paolo
authors.initials: P
authors.lastname: Vincenzi
authors.forename: Luca
authors.initials: L
authors.lastname: Favero
authors.forename: Manuela
authors.initials: M
authors.lastname: Martini
authors.forename: Andrea
authors.initials: A
authors.lastname: Rubboli
authors.forename: Filippo
authors.initials: F
authors.lastname: Ottani
authors.forename: Leonardo
authors.initials: L
authors.lastname: Varotto
authors.forename: Alessandro
authors.initials: A
authors.lastname: Fontanelli
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary / Q000379:methods* / Q000706:statistics & numerical data; D016208:Databases, Factual; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*; D011446:Prospective Studies; D011859:Radiography; D015607:Stents / Q000706:statistics & numerical data*; D013318:Stroke Volume / Q000502:physiology