Comparison of clinical, angiographic, and intravascular ultrasound parameters after direct stenting versus predilation

The use of coronary stents has increased exponentially over the last decade since 2 large randomized trials demonstrated that stents decrease restenosis and increase event-free survival at 6 months. Currently, a stent placement is recommended for all coronary lesion types in coronary vessels >2.7 mm, bypass lesions, and restenotic lesions, as well as "bail out" situations. 3-5 The standard stent implantation technique requires routine predilation with a balloon catheter to allow an easy passage of the stent and to enhance a complete expansion of all stent modules. Improved stent design has enabled placement of stents without predilation. In addition to a decrease in procedural time and radiation exposure, direct stenting may cause less trauma of the vessel wall. However, the magnitude of stent expansion and the incidence of restenosis after direct stenting has not yet been fully assessed. 11 Therefore, it was the aim of this report to determine stent expansion patterns following direct stenting versus predilation by intravascular ultrasound (IVUS) and to compare the rates of restenosis and major cardiac events at 6 months of follow-up.