Experience of direct coronary stenting at National Institute of Cardiovascular Diseases

To assess the efficacy, safety and advantage of direct coronary stenting versus traditional angioplasty and stenting.

From May 2000 to June 2001, 486 patients underwent PTCA procedure. One hundred fifteen (24%) were considered candidates for direct stenting. Out of 150 coronary lesions, 119 (79%) had direct coronary stenting. In 5% patients stent could not be passed across the lesion. These stents were withdrawn without stent damage and after predilatation the same were successfully deployed.

Primary success rate was 95%. Angiographically assessed success was achieved in all patients with immediate TIMI 111 flow in 97%. The vessels directly stented were LAD 53%, RCA 27% and LCX 18%. Two saphenous vein grafts were also directly stented. The coronary lesions stented were type A 36%, B1 54% and B2 10%. In borderline lesions IVUS was used for quantification of stenosis. There was no in-hospital death, MI or emergency CABG. Compared to traditional stenting there was 46% reduction in procedure time, 62% reduction in radiation exposure time and 35% decrease in use of contrast media. There was also significant (18%) cost benefit in direct stenting.

This study supports the view that direct coronary stenting is feasible and a safe procedure in our population with additional benefits of cost reduction by 18%. We recommend direct stenting in appropriately selected patients.