ABSTRACT
Multicenter randomized trials have demonstrated that restenosis and repeat revascularization are reduced and event-free survival at 6 months is increased when elective stent implantation is performed' in carefully selected patients and coronary lesions. Therefore, in the majority of centers intracoronary stent placement is now used in more than 80% of the percutaneous coronary interventional procedures. The standard stent implantation technique includes pre- dilatation of the lesion with a balloon cather followed by stent implantation. The new generation of stents is reliably pre-mounted on high pressure compatible balloons with a very low profile stent delivery system that allows direct stent implantation without pre- dilatation in high proportion of patients who are candidates for. PCI
Aim of the Work: In this work we compare short and long-term [6 months] outcome of direct coronary stenting, with standard PTCA followed by coronary stenting
Subjects and Method: This study included 80 patients with IHD whom were proper candidates for PCI in the form of coronary artery stenting with or without pre- dilatation, patients were divided into two groups: Group [1] Included 40 patients treated by direct coronary stenting technique and Group [2] included 40 patients treated by standard balloon angioplasty and stent implantation. All patients subjected to complete history taking and thorough clinical examination, 12-lead surface ECG, Coronary angiography followed by PCI procedure and stenting with and without predilatation and follow-up repeated clinical evaluation and coronary angiography was done for all patients 6 month's after PCI for detection of restenosis of the dilated vessel
Results: we found no statistically significant difference between the two groups regarding age, sex, prevalence of smoking, hypertension, diabetes mellitus, the family history, history of previous coronary artery disease and cholesterol level. There was no statistically significant difference between both groups regarding lesion morphology before dilatation and after dilatation. And there were no significant difference in maximal inflating pressure. But there was highly. significant difference between both groups regarding mean flouro-time used in both procedure [less flouro-time in group [1]] highly significant difference in total procedural time and amount of dye used in the procedure [less total procedural time and less amount of dye used in the group [1]]. There were no significant difference between two groups regarding procedural complications and follow up complications. Also, there was no significant difference between both groups regarding restenosis rate in the follow up coronary angiography, [restenosis occurred in 11 patients in group [1] 27.5%, and in 13 patients in the group [2] 32.5%]
Conclusion: From this study we concluded that: Direct stenting in selected lesions seems to be safe and feasible procedure. The procedural, in-hospital and long-term clinical and angiographic outcomes are equivalent comparing group [1] with group [2], The demonstrated benefits of direct stenting approach were the reduction of the amount of dye, reduction of fluoro-time, reduction of the total procedure time, saving the balloons of pre-dilatations, so, reduction of the total procedure cost and reduction of radiation exposure risk on intervention team. So, we recommend the use of direct stenting whenever indicated