Procedural Efficiency of Direct Stenting Versus Predilatation in Type A and B1 Coronary Lesions

Background/Objectives: The optimal stent deployment strategy for low-complexity Type A and B1 coronary lesions remains poorly defined. We compared direct stenting (DS) and predilatation followed by stenting (PS) in elective percutaneous coronary intervention (PCI) for these lesions. Methods: This single-center, retrospective study included adults undergoing elective PCI with drug-eluting stents for ACC/AHA Type A or B1 lesions between June 2020 and December 2025. Procedure duration, cumulative contrast volume, and cumulative reference air kerma were compared using generalized estimating equations accounting for within-patient clustering, adjusted for clinical, lesion-related, procedural, and operator-related factors. Results: In total, 324 patients contributed 334 PCI observations (PS: 239; DS: 95). After adjustment, DS was associated with lower contrast volume (-18.12 mL; 95% CI -28.08 to -8.17; p < 0.001) and lower cumulative reference air kerma (-223.54 mGy; 95% CI -259.98 to -187.11; p < 0.001), whereas procedure duration did not differ significantly (-0.92 min; 95% CI -4.56 to 2.71; p = 0.619). Findings were consistent when restricted to the first PCI per patient. Conclusions: In these lesions, DS was associated with lower contrast volume and cumulative reference air kerma, without a significant adjusted difference in procedure duration. As nonrandomized observations, these findings do not establish equivalence in clinical safety or effectiveness, nor do they demonstrate cost-effectiveness.