Direct coronary stenting without balloon predilation in acute coronary syndromes

Direct coronary stenting without balloon predilation in acute coronary syndromes

Background This prospective, observational study was designed to evaluate the feasibility and the safety of a new strategy for stenting in acute coronary syndromes: direct stent implantation without predilation of the culprit lesion. This strategy might reduce both the cost of the procedure and the...

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Bibliographic Details
Published in:The American heart journal Vol. 138; no. 1; pp. 55 - 59
Main Authors: Hamon, Martial, Richardeau, Yves, Lécluse, Emmanuel, Saloux, Eric, Sabatier, Rémi, Agostini, Denis, Filmont, Jean-Emmanuel, Grollier, Gilles, Potier, Jean-Claude
Format: Journal Article
Language:English
Published: New York, NY Mosby, Inc 01-07-1999
Elsevier
Subjects:
Aged
Angina, Unstable - diagnostic imaging
Angina, Unstable - therapy
Angioplasty, Balloon, Coronary - methods
Biological and medical sciences
Coronary Angiography
Diseases of the cardiovascular system
Feasibility Studies
Female
Humans
Male
Medical sciences
Middle Aged
Myocardial Infarction - diagnostic imaging
Myocardial Infarction - therapy
Prospective Studies
Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)
Stents
Treatment Outcome
Human
Infarct
Angioplasty
Coronary artery
Instrumentation therapy
Cardiovascular disease
Instrumental dilatation
Coronary heart disease
Myocardial disease
Stent
Myocardium
Technique
Variant angina
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Summary:Background This prospective, observational study was designed to evaluate the feasibility and the safety of a new strategy for stenting in acute coronary syndromes: direct stent implantation without predilation of the culprit lesion. This strategy might reduce both the cost of the procedure and the rate of no-reflow, a phenomenon that is more frequently observed during dilation of unstable plaques. Methods and results Between September 1997 and March 1998, 122 carefully selected patients with unstable angina or acute myocardial infarction were included in this study. Highly calcified lesions and vessels with excessive proximal tortuosity were excluded. The procedure was successful in 96% of cases. In 5 cases the stent failed to pass through the stenosis and was successfully retrieved in the guiding catheter in 3 cases. In 2 cases the stent was lost in the peripheral circulation. Transient no-reflow occurred in only 3 cases and was rapidly reversed by rescue use of an intracoronary bolus injection of a glycoprotein IIb/IIIa receptor inhibitor in 2 cases. A patient treated by primary angioplasty with cardiogenic shock on admission died 48 hours after the initial procedure because of irreversible cardiac failure. One-month clinical follow-up was obtained by telephone for all patients; no major coronary events occurred during this period. Conclusions Direct coronary stenting without balloon predilation can be safely performed in acute coronary syndrome–related lesions in selected patients. A randomized, controlled study is warranted to confirm the promising results of this pilot study, especially regarding the low rate of the no-reflow phenomenon. (Am Heart J 1999;138:55-9.)
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ISSN:0002-8703
1097-6744
DOI:10.1016/S0002-8703(99)70246-2