[Direct stent implantation: feasibility, advantages and disadvantages]

Coronary stent implantation was firstly performed as only a bail-out procedure for poor angioplasty results, but nowadays it has become a primary modality of coronary revascularization. The deployment of intracoronary stents during percutaneous transluminal coronary angioplasty has been shown in a number of clinical trials to provide additional benefits regarding the rate of restenosis and clinical outcome over angioplasty alone. Direct stent implantation is the term applied to the technique of coronary stent implantation without firstly preparing the way with balloon predilation. In simple lesion subsets, both initial success rate and restenosis rate are superior to conventional balloon angioplasty. There is a considerable potential advantage of direct stenting over conventional stenting with respect to savings in procedural time, contrast load, and fluoroscopy time. Because predilation is not employed, there is an additional saving on angioplasty balloons, and a more efficient and less usage of stents is possible by minimizing the dissection rate. Lesion selection plays a major role in the high success rates. Long, heavily calcified lesions, small vessels or lesions with excessive proximal tortuosity are not considered suitable for direct stenting. With additional experience and continued improvement in stent technology it seems likely that more patients will be potential candidates for direct stenting.