Multicenter randomized comparison of direct vs. conventional stenting: the DIRECTO trial

With conventional stenting, predilatation frequently induces dissections that require deploying stents longer than originally planned. To assess whether direct stenting is safe and may prevent dissections and reduce the length of stents implanted, we conducted a randomized study comparing direct (n = 73) and conventional (n = 78) stenting. Direct stenting was successful in 89% of cases, 11% crossed over to predilation without complications. Dissections occurred more frequently in conventional stenting group (10.3% vs. 1.4%; P = 0.034), but did not translate to a significant stent length difference (16.31 +/- 7.6 vs. 15.31 +/- 5.5; P = NS). Periprocedure creatine kinase elevation and number of balloons utilized were lower with direct stenting.