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[Direct Stenting without Predilation: a Single-Center Experience with 1,000 Lesions]
Iñigo Lozano1, Ramón López-Palop, Eduardo Pinar
1Sección de Hemodinámica, Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
Insights
Direct stenting is a safe and effective technique in daily practice, offering significant benefits. This study confirms its low rates of complications like dissection and need for postdilation.
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Medical Device Technology
Background:
- Direct stenting offers advantages over traditional methods, including reduced costs, procedure time, radiation exposure, and contrast agent usage.
- Evaluating the real-world application of direct stenting is crucial for understanding its practical benefits and limitations.
Purpose of the Study:
- To analyze the outcomes and safety of direct stenting in a large cohort of patients undergoing percutaneous coronary interventions.
- To identify factors associated with the failure of direct stenting and assess complication rates.
Main Methods:
- Retrospective analysis of 1,000 consecutive lesions treated with direct stenting.
- Assessment of primary success, dissection, need for post-dilation, embolism, stent loss, and side branch occlusion.
- Evaluation of patient demographics and lesion characteristics, including thrombus, calcification, and vessel anatomy.
Main Results:
- A primary success rate of 93.1% was achieved in 1,000 direct stenting procedures.
- Complications included dissection (requiring additional stenting in 40 lesions) and thrombus embolism (7 cases).
- Factors associated with direct stenting failure included circumflex artery location (38%), calcification (26%), angulation (22%), and tortuosity (31%).
Conclusions:
- Direct stenting is a safe and feasible technique in routine clinical practice.
- The procedure demonstrates a low incidence of dissection, need for post-dilation, and embolic events.
- Careful patient and lesion selection can optimize outcomes for direct stenting procedures.
Introduction:
Direct stenting has been shown to save costs, procedural time, radiation, and contrast use. We analyze the results of direct stenting in daily practice.
Material And Methods:
We retrospectively analyzed the interventions in the first 1,000 lesions that were treated with direct stenting at our center. Primary success, dissection, need for additional dilation, embolism, stent loss, and side branch occlusion were the variables assessed.
Results:
Direct stenting was attempted in 1,000 lesions in 784 patients (age 63 11 years, females 21%, diabetes 37%). Primary or rescue angioplasty was performed in 8%. One or more thrombi were found in 16%, bifurcation in 9%, calcification in 5%, angulation in 2.3%, and tortuosity in 3.2%. The reference diameter was 3.0 0.5 mm. The primary success rate was 93.1%. Failure of direct stenting (6.9%) was associated with the circumflex artery in 38%, calcification in 26%, angulation in 22%, and tortuosity in 31%. In 39 lesions, additional dilation with different balloons was required. Additional stenting was required for dissection in 40 lesions and secondary to incomplete coverage of the lesion in 27. Thrombus embolism occurred in 7 lesions, 6 of them with a previously visible thrombus and one in a vein graft. Stent embolisms occurred in 6 cases, 4 of which were retrieved. Four side branches became occluded, but 2 of them were recovered at the end of the procedure.
Conclusions:
Direct stenting is a safe technique with low percentage of dissection, need for postdilation, thrombus embolism, and side br