Direct coronary stenting without predilatation: clinical application, cost benefits and factors affecting success
10.3760/j:issn:0253-3758.2001.01.003
- VernacularTitle:直接冠状动脉支架置入术的临床应用及影响因素
- Author:
Chuanyu GAO
1
;
Whitbourn ROBERT
Author Information
1. Henan Provincial Hospital
- From:
Chinese Journal of Cardiology
2001;29(1):5-7
- CountryChina
- Language:Chinese
-
Abstract:
Objective To assess the clinical application feasibility and affecting factors of direct stent implantation without balloon predilatation. Methods We studied a consecutive series of 604 patients underwent coronary stent procedures at a single centre and compared lesion characteristics, in-hospital outcome, in-laboratory equipment costs and radiation exposure parameters of direct stent implantation (n=237) with the standard coronary stent implantation technique (predilatation before stent deployment, n=367). Results In 254 patients, direct stenting (without predilatation) was attempted and successfully deployed in 237 patients (93.3%), representing 39.2% of all stenting procedures. In direct stent group, 17 patients (6.7%) failed to implant the stent directly (7 patients had moderate vessel calcification, 6 patients had a very tortuous coronary, 4 patients had irregular plaque); 44 patients (18.6%), who had successful direct stenting, underwent further post-dilatation with another balloon in order to achieve an optimal angiographic result. Lesions in the direct stenting group were predominantly type A (52.7%) and type B (40.1%). In standard stenting group, dominant lesions were type B (45.2%) and type C (39.6%). Compared to standard coronary stenting technique, there was no significant difference in number of stents used per patient (1.33±0.64 vs 1.43±0.65, P>0.05) or number of stented vessels per patient (1.10±0.33 vs 1.10±0.34, P>0.05). However, the direct stented patients required less expenditure on coronary interventional equipment (US$ 1 286.2±592.2 vs US$ 1 687.9±586.8, P<0.001), used less contrast (239.7±86.4 ml vs 292.1±105.7 ml, P<0.001) and were exposed to less radiation dose (60.7±34.3 Gy vs 85.5±52.7 Gy, P<0.001) and X-ray exposure time (10.6±7.0 min vs 16.3±12.4 min, P<0.001). The major in-hospital complications (death, Q-MI, revascularization) were less in the direct group than that in standard coronary stenting group (0.4% vs 4.3%, P<0.005). Conclusion In a selected coronary lesion subset, avoiding calcified, long lesions or vessels with severe tortuosity, selective direct stent implantation without predilatation can be safely performed. This alternative direct stent implantation approach is clinically feasible, associated with low rates of ischemic complications, lesser radiation exposure and cost savings with respect to coronary interventional equipment uses.
