Direct coronary stenting: Effect on coronary blood flow, immediate and late clinical results

Abstract

Direct stenting (DS) was attempted in 99 coronary lesions in 94 patients while standard stenting (SS) was attempted in 113 lesions in 103 patients matched for clinical characteristics, stenosis type, and location and stent type. The angiographic result was also evaluated according to TIMI frame count method (TFC) before and after procedure. A clinical follow-up was performed 1 year after the procedure. Before the procedure, TIMI grade 3 flow was detected in 42 cases (42.4%), grade 2 in 40 cases (40.4%), grade 1 in 5 cases (5.1%), and grade 0 in 12 cases (12.1%) in the DS group; these data were similar in SS group. After the procedure, TIMI grade flow was 3 in 90 cases (92.8%) in DS group and in 87 (77.0%) in SS group (P < 0.005); grade 2 was observed in 7 case (7.2%) in DS group and in 25 (22.1%) in SS group (P < 0.005). Major adverse cardiac events during hospitalization and at follow-up were similar in two groups. Radiation exposure time and procedure costs per lesion were significantly reduced in DS group compared to SS group (10.1 +/- 8 min vs. 13.9 +/- 4.7 min, P < 0.001; and 1901 +/- 687 Euro vs. 2352 +/- 743 Euro, P < 0.001, respectively). This study confirms that, in selected patients, direct stenting is a safe and successful procedure, allowing a significant reduction in radiation exposure time and procedural costs compared to standard stenting technique. The angiographic success is confirmed by the improvement in TFC in all cases.

Radiation Exposure to Patients Undergoing Percutaneous Coronary Interventions

“…Mean values were reported in the range of 8.2-21 min for PCI [14,22,39,46], of 8.7-16 min for PCI plus stenting [9-11, 21, 22], and of 10.1-12.6 min for direct stenting [9][10][11]21]. In this study, T F indeed increased for complex interventions like recanalizations of chronic coronary occlusions, emergency interventions, and ELCA.…”

“…T F is widely considered to be a main criterion for the complexity of PCI and the operator's efforts to reduce patient DAP [2,6,9,11,14,21,39,41,43]. Mean values were reported in the range of 8.2-21 min for PCI [14,22,39,46], of 8.7-16 min for PCI plus stenting [9-11, 21, 22], and of 10.1-12.6 min for direct stenting [9][10][11]21].…”

Immature platelet fraction and high-on treatment platelet reactivity with ticagrelor in patients with acute coronary syndromes

“…In addition to mechanical devices and stent technology [23][24][25], large improvement have been achieved in antithrombotic strategies that allow to prevent a large quote of ischemic complications, especially in-stent thrombosis [26][27][28][29].…”

Multicentre experience with MGuard™ net protective stent in ST‐elevation myocardial infarction: Safety, feasibility, and impact on myocardial reperfusion

“…TIMI antegrade coronary flow and cTFC pre-and post-PCI as well as postprocedural MBG were assessed as previously reported [23,24]. Two independent observers read all the angiograms, with divergences resolved by consensus.…”