Efficacy and safety of direct coronary stenting: acute outcome of direct stenting in type A, B, and C lesions

ABSTRACT

Direct stent implantation is the unique technique of an intracoronary stenting without lesion predilation. It acquired sound acceptance and popularity due to shorter procedural time, fewer contrast dose and reduced incidence of clinically relevant dissections, furthermore, cost effectiveness and less radiation exposure favor this approach. However, the abuse of this technique may result in worse outcome. The objective beyond this study was to assess the safety and feasibility of the direct stenting in different lesion subsets [Type A, B and C]. A prospective non randomized study of 78 patients with total of 84 lesions [29 type A, 41 type B, and 14 type C] underwent direct stenting., Lesions were classified accordingto AHA/ACC task force. TIMI flow before and after procedure, dissectons, perforation, residual diameter stenosis and side branch compromization all were considered. Initial deployment was successful in 80 out of 84 lesions, three lesions successfully stented following predilation. A stent was unable to be deployed in only lesion; however, the lesion was treated with balloon angioplasty alone, all were complex type C lesions and excluded from study. The majority of lesions required only 1 stent [an average of 1.03 stents was used per lesion]. Compared with pre-procedural TIMI flow, post procedure TIMI flow has improved in all lesion subsets, however, it didn't reach a statistical significance except in type B lesions [p=0.007], residual diameter stenosis was significantly higher in type C compared to Type B and A lesions [32.0, 11.62 and 1.67% respectively, p=0.001], side branch compromization observed in 60%, 35.9% and 17.2% in type C, B and A lesions respectively [0.0 15]. Distal dissection observed in 60%, 2.4% and 0% in type C, B and A lesions respectively [p=0.002]. Vessel perforation has complicated primary stenting of type C lesion that successfully treated by prolonged inflation and deployment of another stent, resulting in procedural myocardial infarction. Direct stenting is a safe and effective method for treating coronary artery disease except for complex type C lesions in which complications are warranted