Direct coronary artery stenting without balloon predilation

OBJECTIVE: Direct stenting of coronary stenosis without balloon predilation has shown to reduce the cost, the duration and the radiation exposure associated with the stenting of coronary artery stenosis. We sought to study the feasibility, safety and immediate learning curve of direct stenting in a Cardiac center in the Kingdom of Saudi Arabia.

METHODS: We prospectively studied 76 consecutive patients with coronary artery stenoses who underwent direct stenting without balloon predilation. This study was carried out at King Fahad Armed Forces Hospital, Jeddah, Kingdom of Saudi Arabia, during the period January 2000 through to November 2001. Patients were selected by the operators based on reference vessel diameter >2.5 mm, absence of calcification, absence of vessel angulation and absence of total occlusion.

RESULTS: Forty-six percent of the patients were diabetics, 34% had post infarction angina, and 60% underwent stenting of the left anterior descending artery. Most vessels (90%) were >3.0 mm in size. Direct stenting was successful in all patients and there were no deaths, no need for urgent bypass surgery, stent thrombosis or embolization. One patient developed a non-Q wave myocardial infarction.

CONCLUSION: Direct stenting without balloon predilation is safe and feasible with almost no learning curve for interventionalists experienced in conventional coronary stenting and can be used for selected patients in centers without prior experience in direct stenting.