DIRECT CORONARY STENTING WITHOUT PREDILATATION IN SELECTED PATIENTS WITH SIGNIFICANT CORONARY ARTERY DISEASE

Background: Direct coronary stenting is the primary therapeutic option for the treatment of many coronary lesions. Depending on the operator’s experience, it can result in a good outcome and low restenosis rates. Objective: To assess the outcome of direct coronary stenting in patients who underwent this procedure. Methods: Two hundred and ten (164 males and 46 females) patients from April 2000 through April 2002, who had significant (> 70%) coronary artery stenosis were included in this study. Patients were recruited from Mehrad, Day, and Pars Hospitals. Direct coronary stenting was performed on unioperator procedure for 162 (77.1%) patients in one location, 43 (20.5%) in two locations, and 5 (2.4%) patients in three locations. Age, sex, involved vessel, failure rate, possible complications, and restenosis rate were assessed. Results: The mean ± SD age of participants was 55.62 ± 10.08 years. The target vessels of those 266 lesions were left anterior descending (LAD) (70.4%), circumflex (CX) (11.7%), right coronary artery (RCA) (8.9%), obtus marginatum (OM) (3.2%), ramus (2.3%), posterior descending artery (PDA) (1.7%), and saphenous vein graft (SVG) on OM (1.7%). Lesion types were graded as A (50%), B1 (20%), B2 (20%), and C (10%). Stents were successfully deployed in 99% of patients and were 2.5 – 3.5 mm in diameter and 8 – 23 mm in length. AVE (32.7%), Nexus (26.7%), Bio (18.8%), Multi-Link (16.1%), Cordis (2.6%), Jomed (1.8%), and others (1.3%) were the stents applied in the lesions of these patients. There were no mortality nor any major in-hospital complications. Seventy percent of patients were closely followed up for at least 6 months. Exercise stress, thallium, and/or angiography tests were performed when indicated. The stent restenosis rate was 1% in short-term (one month) and 14% in long-term (six months) follow-up. Conclusion: Good short- and long-term results of stent implantation without predilatation will be obtained in carefully selected patients. This technique can be used in the high grades (B2, C) of lesions safely and effectively. Furthermore, direct stenting can reduce the radiation exposure, costs of hospitalization, and the operation time.