Predilation Stenting Research Articles

A COMPARATIVE ANALYSIS OF DIRECT STENTING VERSUS PRE-DILATION IN ST-ELEVATION MYOCARDIAL INFARCTION

A major cardiovascular emergency, ST-Elevation Myocardial Infarction (STEMI), needs prompt and efficient intervention to restore blood flow to the ischemic myocardium. The decision between direct and pre-dilation stenting, two of the many techniques used in primary percutaneous coronary intervention (PCI), has been a topic of continuous discussion. This comparative study was performed at Ayub Teaching Hospital Abbottabad after obtaining approval from the ethical review committee for six months. A total of 75 patients were included in this study and were divided into two groups. The documented procedural outcomes were the use of Gp IIb/IIIa inhibitors, procedure time, total procedure cost, and procedural problems. The rates of the left ventricular ejection fraction (LVEF) at discharge, ventricular fibrillation, all-cause death, and a composite of major adverse cardiac events at 30-day follow-up were documented. The results have shown that Group A has 2.44% cases of no re-flow and no abrupt closure or dissection occurrences. Group B's incidence rates were 5.88%, 2.94%, and 5.88%, respectively. The procedural time, Group A had an average of 33 ± 19 minutes, while Group B recorded a longer procedural time of 41 ± 17 minutes. Postoperatively, Group A showed a mean LVEF of 49.2 ± 8.8, no cases of cardiogenic shock or stroke, and a mortality rate of 2.44%. In contrast, Group B had a mean LVEF of 48.9 ± 9.2, encountered cardiogenic shock in 5.88% of cases, experienced a stroke in 2.94%, and recorded a mortality rate of 2.94%. Additionally, both groups exhibited ST-segment resolution, with rates of 80.49% in Group A and 67.64% in Group B. The analysis of patients undergoing coronary intervention for ST-elevation myocardial infarction (STEMI) suggests that direct stenting may yield more favorable results compared to pre-dilation.

The SIRIUS‐DIRECT trial: A multi‐center study of direct stenting using the sirolimus‐eluting stent in patients with de novo native coronary artery lesions

To assess the safety and efficacy of direct stenting using the sirolimus-eluting BX Velocitytrade mark stent in patients with coronary lesions. Although direct coronary stenting has become a widespread practice, there have been no systematic assessments of direct stenting with drug-eluting stents. Total of 225 patients with identical inclusion and exclusion criteria as the original SIRIUS trial were enrolled in this prospective single-arm study. They were compared in a no-inferiority design with 412 similar patients from the SIRIUS trial who had sirolimus-eluting stents deployed after predilatation and were preassigned to angiographic follow-up evaluation. Direct stenting was successful in 85.8% of the patients. Compared with the predilatation group, direct stenting was associated with shorter median procedure duration (33 min vs. 45 min, P < 0.001). Angiographic follow-up at 8 months revealed similar late loss (in-stent-0.19 +/- 0.47 mm vs. 0.17 +/- 0.44 mm, and in-lesion-0.23 +/- 0.41 mm vs. 0.24 +/- 0.47 mm) and similar frequency of binary restenosis (in-stent-4.6% vs. 3.2% and in-lesion-6.1% vs. 8.9%) between the two treatment strategies. However, stent-edge restenosis was lower with direct stenting than in the predilatation control group (2.1% vs. 6.9%, P = 0.02). At 12-months, there were no significant differences in target lesion revascularization (3.7% vs. 5.1%, P = ns) or composite major adverse cardiac events (7.0% vs. 8.3%, P = ns). In patients similar to those treated in the SIRIUS trial, direct stenting using sirolimus-eluting stents achieves excellent short- and long-term clinical and angiographic results with shorter procedure time and less frequent stent edge restenosis compared with predilation stent implantation techniques.

Implante direto de stent coronariano: efeitos na resposta inflamatória sistêmica

INTRODUÇÃO: O implante direto de stent, potencialmente menos traumático do que a técnica convencional com prédilatação, por permitir simultaneamente o remodelamento da placa ateromatosa e o tratamento de eventual dissecção, resultaria em redução da resposta inflamatória sistêmica. OBJETIVO: Comparar as técnicas direta e convencional de implante de stent quanto aos efeitos na resposta inflamatória sistêmica. MÉTODO: Pacientes encaminhados para implante eletivo de stent coronariano foram divididos em dois grupos, direto e convencional. A resposta inflamatória sistêmica foi avaliada pela variação pré e pós-intervenção dos níveis séricos de proteína C reativa (PCR-us) e CD40L. RESULTADOS: Foram incluídos 34 pacientes no grupo direto e 26 no grupo convencional. Os dados demográficos e angiográficos foram semelhantes entre os grupos direto e convencional, respectivamente: idade 58,0±11,6 e 59,5±9,8 (p=0,60); sexo masculino 67,6% e 69,2% (p=0,99); diabéticos 17,7% e 26,9% (p=0,53); lesões B2/C 52,9% e 38,5% (p=0,31) e diâmetro de referência pré-intervenção (mm) 2,67±0,7 e 2,81±0,7 (p=0,45). Pós-intervenção para ambos os grupos houve elevação semelhante dos níveis séricos de PCR-us (p tempo<0,001; p interação=0,86; p grupo=0,22) e redução similar dos níveis séricos de CD40L (p tempo=0,02; p interação=0,81; p grupo=0,39). CONCLUSÃO: As técnicas direta e convencional de implante de stent coronariano foram equivalentes quanto a seus efeitos na resposta inflamatória sistêmica.

Results of the PIXEL study: randomized multicenter trial comparing direct and conventional predilation stenting in small vessels

Results of the PIXEL study: randomized multicenter trial comparing direct and conventional predilation stenting in small vessels

Comparison of luminal enlargement by direct coronary stenting versus predilation coronary stenting by three-dimensional volumetric intravascular ultrasound analysis

S tudies using planar intravascular ultrasound (IVUS) have shown that during intracoronary stent implantation, the mechanisms of lumen enlargement are similar to those of balloon angioplasty, with significant plaque redistribution and extrusion, vessel expansion, and plaque reduction. However, these assessments were performed with stents implanted after predilation by balloon. New stents, crimped onto their low-profile flexible delivery systems, with more rapid tapering of the balloon outside of the conical markers, are suitable for direct stenting (DS). DS has become routine in some laboratories. This new therapeutic approach of DS without predilation provides a way to rationalize stent implantation with the potential of less ischemic complications, less use of balloons, and less x-ray exposure. Although DS has become widespread, the mechanism by which it causes lumen enlargement is still unknown. Furthermore, there remains concern about the risk of microplaque embolization with DS. The present 3-dimensional volumetric IVUS study compares the mechanisms of lumen enlargement with DS versus predilation stenting (PDS) using the same contemporary stent design and the same stent length. • • • We retrospectively studied 30 patients with DS and 30 patients with PDS of nonostial, noncalcified, native coronary lesions treated with the same stent design and dimensions (ACS Multilink DUET or TRISTAR stent, Guidant Corporation, Santa Clara, California) and the same stent length (13 mm). The decision to predilate or not to predilate was partly based on general operator attitude. All lesions in both groups had met the inclusion criterion of the physical feasability of preintervention IVUS examination. Consequently, the DS success rate was 100%. For each procedure, the number of inflations, the maximum balloon inflation pressure, and the diameter of the stent used were recorded. Stent-to-artery ratio was defined as the diameter of the stent (according to the linear compliance curve of the balloon and the maximum balloon inflation pressure) divided by the reference luminal diam-

Repeat Dilation of Palmaz Stents in Pulmonary Arteries: Study of Safety and Effectiveness in a Growing Animal Model

This study assessed the technical feasibility and safety of repeat dilation of Palmaz stents in growing pulmonary arteries. Palmaz stents (1.2 cm long) were placed percutaneously into the pulmonary arteries of 20 newborn lambs. After 4 months, pulmonary arteriography was performed. Where vessel growth in excess of stent diameter had created a stenosis (> 15%), stents were dilated again percutaneously. Six months later, pulmonary arteriography was performed, before the animal was killed and histologic examination performed. Twenty-four pulmonary artery stent placements were attempted; 23 were successful. One stent placement was unsuccessful owing to stent displacement from the balloon. Acute complications included branch pulmonary artery occlusion (n = 3) and stent displacement from the delivery balloon (n = 2). At 4 months, the desired degree of stenosis (> 15%) was achieved in 11 animals. The average stenosis was 35% (standard deviation, 16%; range, 17%-66%). The mean predilation stent diameter was 6 mm +/- 1.1 (range, 4-8 mm), and the final diameter of 8 mm +/- 1.4 (range, 6-10 mm), represented a 35% mean increase (P < .001). Complications included stent (n = 1) and branch vessel (n = 1) thrombosis. At 6-month follow-up, all stents were patent. Areas of previously noted branch thrombosis were fully recanalized in all cases. At histologic inspection, only a thin layer of neointima was found on the stents. Repeat dilation of Palmaz stents may be safely performed in growing pulmonary arteries in an animal model. Neointimal hyperplasia is minimal in pulmonary artery stents.