Provisional stenting      2000-2001

TCTMD - The Great Debate Slide Sets

An introduction to provisional stenting
Carlo Di Mario; Nico HJ Pijls
International Journal of Cardiovascular Interventions 2001;4:59-65.
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Provisional stenting in small vessels
Flavio Airoldi; Carlo Di Mario; Takuro Takagi; Goran Stankovic; Remo Albiero; Antonio Colombo
International Journal of Cardiovascular Interventions 2001;4:91-98.
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Intravascular ultrasound-guided percutaneous transluminal coronary angioplasty with provisional spot stenting for treatment of long coronary lesions
Colombo A, et al.
J Am Coll Cardiol 2001;38:1427-33
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11691519 

Pressure wire guide provisional coronary stent implantation
Nakamura S, et al.
J Cardiol 2001;37:191-9
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11337928 

Achieving optimal results with standard balloon angioplasty: can baseline and angiographic variables predict stent-like outcomes?
Cantor WJ, et al.
J Am Coll Cardiol 2001;37:1883-90
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11401127 

DESTINI - Randomized comparison of elective stent implantation and coronary balloon angioplasty guided by online quantitative angiography and intracoronary doppler
  Di Mario C || Colombo A
  Circulation 2000;102:2938-44
  http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0011113043
  Click here to view the full article in PDF
  Figure & table
Lack of significant difference in early and late clinical outcomes between elective stenting and PTCA guided by online QCA and Doppler-derived coronary flow reserve, with provisional stenting reserved for suboptimal results.

DEBATE II - Randomized comparison of primary stenting and provisional balloon angioplasty guided by flow velocity measurement
  Serruys PW || van Hout B
  Circulation 2000;102:2930-7
  http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0011113042
  Figure & table
Lack of significant difference between clinical outcomes when comparing primary stenting with provisional stenting

Editorial
Provisional versus routine stenting : routine stenting is here to stay
  Anderson HV and Carabello BA
  Circulation 2000;102:2910-4
  Click here to view the full article (Review)
It is fair to say that routine stenting wins over provisional stenting for these reasons:
  1) is associated with improved clinical outcomes at 1 to 2 years compared with PTCA and provisional stenting
  2) stents have brought a dramatic reductions in adverse clinical events
  3) a high percentage of provisional strategy patients ultimately receive stents 
  4) routine stenting has more favorable economics than provisional stenting

OPUS-1 - Optimum percutaneous transluminal coronary angioplasty compared with routine stent strategy trial: a randomised trial
  Weaver WD || Every NR
  Lancet 2000;355:2199-203
  http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0010881893
Routine stent implantation leads to better acute and long-term clinical outcomes at a cost similar to that of initial balloon angioplasty with provisional stenting.

FROST - The French Randomized Optimal Stenting Trial: a prospective evaluation of provisional stenting guided by coronary velocity reserve and quantitative coronary angiography. F.R.O.S.T. Study Group
  Lafont A || Kern M
  J Am Coll Cardiol 2000;36:404-9
  http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0010933349
Lack of difference in restenosis at 6 months between systematic stenting and provisional stenting.

BOSS - Balloon optimization versus stent study: provisional stenting and early recoil after balloon angioplasty
  Dangas G || Fischman DL
  Am J Cardiol 2000;85:957-61
  http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0010760334
Lack of significant difference in late restenosis rate when comparing elective stenting with "optimal" PTCA and provisional stenting 

WIDEST - Is provisional stenting the effective option? the WIDEST study (Wiktor stent in de novo stenosis)
  Fluck DS || Layton CA
  Heart 2000;84:522-8
  http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0011040014
Lack of significant difference between clinical outcomes when comparing elective stenting with PTCA and provisional stenting (the need for further revascularisation at one year was 18.2% in the stented group vs 17.1% in the PTCA group). This 9 centre, multinational, study randomised 300 patients with a single coronary lesion. Crossover rate of 30.1% in the PTCA group.