DIRECT STENTING VERSUS BALLOON PRE-DILATATION IN ELECTIVE PERCUTANEOUS CORONARY INTERVENTION

Khurram Shahzad, Nadeem Hayat Mallick, Shahid Amin, Sajjad Ahmad, Hazrat Ullah

Abstract


Background: Stents are now deployed in almost 95% of all percutaneous coronary interventions (PCIs). Recent advances in balloon and stent technology has improved the technique of direct stent (DS)  strategy i.e., stent delivery without pre-dilatation instead of conventional stenting (CS), i.e., stent implantation after balloon pre-dilatation with multiple advantages. Methods: This randomized controlled trial was conducted at the Cardiology. Department, Punjab Institute of Cardiology, Lahore from April to September, 2017. One hundred patients who were being treated by percutaneous coronary intervention (PCI) were enrolled into two Groups e.g., Group I & group II. 50 patients undergoing direct stenting were enrolled in group I and 50 patients undergoing stenting after balloon pre-dilatation were enrolled in group II after randomization. All patients were treated by single type drug eluting or bare metal stents. Chi square test was used for association and t-test for mean difference between two groups in comparison to post dilatation, fluoroscopy time, procedure time, amount of contrast used, procedural success, side branch compromise, slow flow. The p-value of ˂ 0.05 was significant. Results This study consisted of 76 males and 24 females out of a total count of 100, with the average age of 52.2±0.01 years. Overall, 43 (43%) patients were diabetic and overall, 44 (44%) were hypertensive. Most of the patients 55 (55%) had PCI to LAD. Average fluoroscopy time 4.l±2.5 minutes in Group I was significantly lesser as compared to 6.7±3.8 minute group II (p-value <0.05). The average procedure time was also marginally lesser in Group I, 23.4±11.6 in comparison to the second Group 33.7±14 (p-value <0.05). Side branch compromise was observed in 10 (20%) in the first group as compared to 8 (16%) the second group. Conclusion: In comparison to stenting preceded by balloon pre-dilatation, direct stenting is a safer and more feasible procedure with respect to radiation exposure, cost and time duration of the procedure.

Keywords: PCI; Coronary artery disease; Stenting directly; Balloon angioplasty


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References


Barbato E, Marco J, Wijns W. Direct stenting. Eur Heart J 2003;24(4):394–403.

Bairn DS, Flatley M, Caputo R, O’Shaughnessy C, Low R, Fanelli C, et al. Comparison of predilatation vs direct stenting in coronary treatment using the Medtronic AVE S670 coronary stent system (The PREDICT trial). Am 1 CardioI 2001;88(12):1364–9.

Martinez-Elbai L, Ruiz-Nodar JM, Zueco J, Lopez-Minguez JR, Moreu J, Calvo I, et al. Direct coronary stenting versus stenting with balloon pre-dilation: immediate and follow-up results of a multicentre, prospective, randomized study. The DISCO trial. Eur Heart J 2002;23(8):633–40.

Ijsselmuiden AJJ, Serruys PW, Scholte A, Kiemeneij F, Slagboom T, v/d Wieken LR, et al. Direct coronary stent implantation does not reduce the incidence of in-stent restenosis or major adverse cardiac events: six month results of a randomized trial. Eur Heart J 2003;24(5):421–9.

Dawkins KD, Chevalier B, Suttorp MJ, Thuesen L, Benit E, Bethencourt A, et al. Effectiveness of "direct" stenting without balloon predilatation (from the Multilink Tetra Randomised European Direct Stent Study [TRENDS]). Am J CardioI 2006;97(3):316–21.

Burzotta F, Trani C, Prati F, Hamon M, Mazzari MA, Mongiardo R, et al. Comparison of outcomes (early and six-month) of direct stenting with conventional stenting (a metaanalysis of ten randomized trials). Am J Cardiol 2003;91(7):790–6.

Hirohata A, Morino Y, Ako J, Sakurai R, Buchbinder M, Caputo RP, et al. Comparison of the efficacy of direct coronary stenting with sirolimus-eluting stents versus stenting with predilation by intravascular ultrasound imaging (from the DIRECT trial). Am J Cardiol 2006;98(11):1464–7.

Ormiston JA, Mahmud E, Turco MA, Popma JJ, Weissman N, Cannon LA, et al. Direct stenting with the TAXIS Liberte drug-eluting stent: results from the Taxus Atlas direct sent study. J Am Coll Cardiol Intv 2008;1(2):150–60.

Cuisset T, Hamilos M, Melikian N, Wyffels E, Sarma J, Sarno G, et al. Direct stenting for stable angina pectoris is associated with reduced peri procedural microcirculatory injury compared with stenting after pre-dilation. J Am Coll CardioI 2008;51(11):1060–5.

Laannan G, Muthusamy TS, Swart H, Westendrop I, Kiemeneij F, Slagboom T, et al. Direct coronay stent implantation: safety, feasibility, and predictors of success of the strategy of direct coronary stent implantation. Catheter Cardiovasc Interv 2001;52(4):443–8.

Pentousis D, Guerin Y, Funck F, Zheng H, Toussaint M, Corcos T, et al. Direct stent implantation without predilatation using the Multilink stent. Am J Cardiol 1998;82(12):1437–40.

Herz J, Assali A, Solodky A, Shor N, Pardes A, Ben-Gal T, et al. Effectiveness of coronary stent deployment without predilatation. Am J Cardiol 1999;84(1):89–91.

Piscione F, Piccolo R, Cassese S, Galasso G, D'Andrea C, De Rosa R, et al. Is direct stenting superior tostenting with predilation in patients treated with percutaneous coronary intervention? results from a meta-analysis of 24 randomised controlled trials. Heart 2010;96(8):588–94.

Briguori C, Sheiban I, De Gregorio J, Anzuini A, Montorfano M, Pagnotta P, et al. Direct coronary stenting without predilatation. J Am Coll Cardiol 1999;34(7):1910–15.

Taylor Al, Broughton A, Fedennan J, Walton A, Keighley C, Haikerwal D, et al. Efficacy and safety of direct stenting in coronary angioplasty. J Invasive Cardiol 2000;12(11):560–5.

Timurkaynak T, Ozdemir M, Cengel A, Ciftci H, Cemri M, Erdem G, et al. Myocardial injury after apparently successful coronary stenting with or without balloon dilatation: direct vs conventional stenting. J Invas Cardiol 2002;l4(4):167–70.

Atmaca Y, Ertas F, Gulec S, Dincer I, Oral D. Effect of direct stent implantation on minor myocardial injury. J Invas Cardio1 2002;14(8):443–46.

Miketic S, Carlsson J, Tebbe U. Clinical and angiographic outcome after conventional angioplasty with optional stent implantation compared with direct stenting without predilatation. Heart 2002;88(6):622–6.

Stys T, Lawson WE, Liuzzo JP, Hanif B, Bragg L, Cohn PF. Direct coronary stenting without balloon or device pretreatment: acute success and long-term results. Catheter Cardiovasc Interv 2001;54(2):158–63.

Ahmed WH. Direct coronary stenting without balloon predilatation . Saudi Med J 2002;23(7):828–30.

Wilson SH, Berger PB, Mathew V, Bell MR, Garratt KN, Rihal CS, et al. Immediate and late outcomes after direct stent implantation without balloon predilatation. J Am Coll Cardio1 2000;35(4):937–43.


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