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Updated: Jul 20, 2026
A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Safety, efficacy and costs associated with direct coronary stenting compared with stenting after predilatation: A
Insights
Direct stenting is a safe and effective alternative to balloon predilatation for coronary artery stenting, offering similar clinical outcomes and modest cost savings. However, calcified lesions may predict unsuccessful direct stenting.
Area of Science:
- Interventional Cardiology
- Cardiovascular Medicine
Background:
- Coronary artery stenting is a common procedure for treating coronary artery disease.
- Balloon predilatation is a standard step prior to stent implantation.
- Direct stenting, bypassing balloon predilatation, may offer advantages.
Purpose of the Study:
- To compare the in-hospital success rates, procedural costs, and short-term clinical outcomes of direct stenting versus stenting after balloon predilatation.
- To identify predictors of procedural success in direct stenting.
Main Methods:
- Randomized trial involving 400 patients with coronary stenoses.
- Patients were assigned to either direct stenting or stenting after balloon predilatation.
- Outcomes assessed included procedural success, clinical events, and procedural costs.
Main Results:
- Procedural success rates were similar between groups (96.0% direct stenting vs. 94.5% predilatation).
- Direct stenting showed modest cost savings (€2545 vs. €2763 per patient) due to reduced fluoroscopy time, contrast use, and balloon utilization.
- Angiographic lesion calcification was an independent predictor of unsuccessful direct stenting (OR 7.1).
- Major adverse cardiac events at 30 days were similar (4.5% vs. 5.5%).
Conclusions:
- Direct stenting is a safe and effective alternative to balloon predilatation.
- The procedure offers modest procedural cost savings.
- Lesion calcification is a key factor predicting direct stenting success.
Objectives:
Comparison of the in-hospital success rates, procedural costs and short-term clinical outcomes of direct stenting versus stenting after balloon predilatation.
Methods:
Altogether, 400 patients with angina pectoris and/or myocardial ischaemia due to coronary stenoses in a single native vessel were randomised to either direct stenting or stenting after predilatation. Baseline characteristics were evenly distributed between the two groups.
Results:
Procedural success rates were similar (96.0% direct stenting group vs. 94.5% predilatation) as well as final successful stent implantation (98.3 vs. 97.8%), while the primary success rate of direct stenting alone was 88.3%, p=0.01. In multivariate analysis, angiographic lesion calcification was an independent predictor of unsuccessful direct stenting (odds ratio 7.1, 95% confidence interval 2.8-18.2, p<0.0001). Rates of troponin I rises >0.15 μg/l, used as a measure of distal embolisation, were similar in both groups (17.8 vs. 17.1%). Rates of major adverse cardiac events at 30 days were 4.5% in the direct stenting group versus 5.5% in the predilated group (ns). Direct stenting was associated with savings in fluoroscopy time, and angiographic contrast agent use, and a reduction in utilisation of angioplasty balloons (0.4 vs. 1.17 balloons per patient, p<0.001). Mean per patient procedural costs associated with direct stenting versus predilatation were €2545±914 versus €2763±842 (p=0.01), despite the implantation of more stents in the directly stented group.
Conclusion:
Compared with a strategy of stenting preceded by balloon predilatation, direct stenting was equally safe and effective, with similar in-hospital and 30-day clinical outcomes, and modest procedural cost-savings. A calcified lesion predicted unsuccessful direct stenting.
