Direct Stenting    2000-01

• www.directstent.org
  The goal of this website is to share high quality and up to date information about Direct Stenting among interventional cardiologists. The information that appears on this site is selected by an independant Editorial Board comprised of international experts in the field.

CCT 2001 The Book
Chapter 15. Direct stenting for AMI

•  kijima15.PDF (about 1MB)

Comparison of PRE-dilatation vs Direct stenting In Coronary Treatment using the Medtronic AVE S670 Coronary Stent System (the PREDICT trial)
Baim DS, et al.
Am J Cardiol 2001;88:1364-1369
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11741553 
The S670 stent showed excellent overall performance. Although direct stenting was safe and highly successful, it offered only modest cost savings, and no reduction in late restenosis compared with stenting after predilatation.

Randomised comparison of coronary stenting with and without balloon predilatation in selected patients
Le Breton H, et al.
Heart 2001;86:302-8
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11514483
This study confirms the feasibility and safety of direct stenting of selected and non-complex coronary lesions. This technique was as successful as the conventional approach and was associated with a minor reduction in fluoroscopic exposure and procedure time and the administration of less contrast agent.

Comparison of direct coronary stenting with and without balloon predilatation in patients with stable angina pectoris. BET (Benefit Evaluation of Direct Coronary Stenting) Study Group
Carrie D, et al.
Am J Cardiol 2001;87:693-8
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11249885
in selected patients, this prospective randomized study shows the feasibility of direct stent implantation with reduction in procedural cost and length, and without an increase in in-hospital clinical events and major adverse cardiac events at 6-month follow-up.

A randomized comparison of direct stenting with conventional stent implantation in selected patients with acute myocardial infarction
Loubeyre C, et al.
J Am Coll Cardiol 2002;39:15-21
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11755281 
In selected patients with AMI, direct stenting can be applied safely and effectively. This strategy may result in a significant reduction of microvascular injury, as suggested by improved ST-segment resolution after reperfusion with major potential clinical consequences.

Direct infarct artery stenting without predilation and no-reflow in patients with acute myocardial infarction
Antoniucci D, et al.
Am Heart J 2001;142:684-90
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11579360 
Direct stenting in patients with AMI may reduce the incidence of angiographic no-reflow, thereby increasing ultimate effective myocardial reperfusion.

Comparison of luminal enlargement by direct coronary stenting versus predilation coronary stenting by three-dimensional volumetric intravascular ultrasound analysis
Finet G, et al.
Am J Cardiol 2001;88:1179-82
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11703967 

Evaluation of direct stent implantation without predilatation by IVUS
  de la Torre Hernandez JM || Colman T
  Am J Cardiol 2000;85:1028-30, A8
  http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0010760351
Direct stent implantation without predilatation in selected lesions provides angiographic and ultrasonographic results that could be comparable to those expected with conventional stenting. These results may even safely improve if a balloon-artery ratio of 1.1 to 1.2 is used in combination with implantation pressures of 12 to 16 atm.

Immediate and late outcomes after direct stent implantation without balloon predilation
  Wilson SH || Holmes DR Jr
  J Am Coll Cardiol 2000;35:937-43  
  http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0010732891
The in- hospital and long-term clinical outcomes of direct stenting are equivalent to those of stenting after predilation. Direct stenting is associated with decreased utilization of contrast agent and equipment and shorter procedure times.

Coronary stenting without predilatation in a broad spectrum of clinical and angiographic situations
  Chan AW || Webb JG
  J Invasive Cardiol 2000;12:75-9
  http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0010731268
Direct coronary stenting was successfully and safely accomplished in a variety of clinical situations in selected patients.

Is the "direct" approach best? (Editorial)
  Webb JG
  J Invasive Cardiol 2000;12:203-5
  http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0010785674 

Efficacy and Safety of Direct Stenting in Coronary Angioplasty
  Taylor AJ || Goods C
  J Invasive Cardiol 2000;12:560-565
  http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0011060569
  Click here to view the full article
Direct stenting is a safe and effective method for treating coronary artery disease. In appropriately selected cases, it has a low rate of procedural failure and results in less contrast usage and fewer distal complications than conventional angioplasty and stenting.

The PREDICT trial
  Direct stenting's edge is mostly one of convenience
  Click here to view the full article
A randomized U.S. trial of 400 patients concluded that direct stenting shortens procedure time and reduces contrast and hardware use as compared with stenting after balloon predilatation. The PREDICT trial also showed that direct stenting was not associated with any increase in complication risk, although this technique also did not offer any clinical or angiographic advantages to balloon predilatation.