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. 2001 Sep;86(3):302–308. doi: 10.1136/heart.86.3.302

Randomised comparison of coronary stenting with and without balloon predilatation in selected patients

H Le Breton 1, J Boschat 1, P Commeau 1, P Brunel 1, M Gilard 1, C Breut 1, O Bar 1, P Geslin 1, A Tirouvanziam 1, L Maillard 1, B Moquet 1, P Barragan 1, P Dupouy 1, G Grollier 1, J Berland 1, P Druelles 1, R Rihani 1, B Huret 1, C Leclercq 1, M Bedossa 1
PMCID: PMC1729902  PMID: 11514483

Abstract

BACKGROUND—The SWIBAP (stent without balloon predilatation) prospective randomised trial was designed to compare direct coronary stenting with stenting preceded by lesion predilatation with an angioplasty balloon.
OBJECTIVE—To determine the feasibility and safety of direct stenting in non-complex coronary lesions in a prospective study.
PATIENTS AND DESIGN—All patients < 76 years of age scheduled to undergo angioplasty of a non-complex, non-calcified lesion in a coronary artery of > 3.0 mm, who granted their informed consent, were randomised into the trial. In group I, the stent was placed without balloon predilatation, while in group II stent implantation was preceded by balloon predilatation. The primary end point was the angiographic result according to procedure assigned by randomisation. An intravascular ultrasound substudy was performed in 60 patients.
RESULTS—Stent implantation was successful without predilatation in 192 of the 197 group I patients (97.5%), and with predilatation in 197 of the 199 group II patients (99%) (NS). No in-hospital stent thrombosis or death occurred. Overall procedural times, fluoroscopy times, and volumes of contrast agent given (mean (SD)) in group I v group II were 23.50 (13.54) min v 27.96 (15.23) min (p = 0.002), 6.04 (4.13) min v 6.67 (3.65) min (NS), and 135 (65) ml v 157 (62) ml (p < 0.001), respectively. No major adverse cardiovascular events had occurred by 30 days.
CONCLUSIONS—The feasibility and safety of direct stenting of selected and non-complex coronary lesions is confirmed. This technique was as successful as the conventional approach and was associated with a minor reduction in fluoroscopic exposure and procedure time and the administration of less contrast agent.


Keywords: coronary artery angioplasty; stent; coronary artery ultrasound

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Selected References

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  1. Briguori C., Sheiban I., De Gregorio J., Anzuini A., Montorfano M., Pagnotta P., Marsico F., Leonardo F., Di Mario C., Colombo A. Direct coronary stenting without predilation. J Am Coll Cardiol. 1999 Dec;34(7):1910–1915. doi: 10.1016/s0735-1097(99)00453-2. [DOI] [PubMed] [Google Scholar]
  2. Danzi G. B., Capuano C., Fiocca L., Dallavalle F., Pirelli S., Mauri L., Quaini E. Stent implantation without predilation in patients with a single, noncalcified coronary artery lesion. Am J Cardiol. 1999 Nov 15;84(10):1250-3, A8. doi: 10.1016/s0002-9149(99)00540-8. [DOI] [PubMed] [Google Scholar]
  3. Figulla H. R., Mudra H., Reifart N., Werner G. S. Direct coronary stenting without predilatation: a new therapeutic approach with a special balloon catheter design. Cathet Cardiovasc Diagn. 1998 Mar;43(3):245–253. doi: 10.1002/(sici)1097-0304(199803)43:3<245::aid-ccd1>3.0.co;2-9. [DOI] [PubMed] [Google Scholar]
  4. Goldberg S. L., Colombo A., Nakamura S., Almagor Y., Maiello L., Tobis J. M. Benefit of intracoronary ultrasound in the deployment of Palmaz-Schatz stents. J Am Coll Cardiol. 1994 Oct;24(4):996–1003. doi: 10.1016/0735-1097(94)90861-3. [DOI] [PubMed] [Google Scholar]
  5. Görge G., Haude M., Ge J., Voegele E., Gerber T., Rupprecht H. J., Meyer J., Erbel R. Intravascular ultrasound after low and high inflation pressure coronary artery stent implantation. J Am Coll Cardiol. 1995 Sep;26(3):725–730. doi: 10.1016/0735-1097(95)00211-l. [DOI] [PubMed] [Google Scholar]
  6. Hamon M., Richardeau Y., Lécluse E., Saloux E., Sabatier R., Agostini D., Filmont J. E., Grollier G., Potier J. C. Direct coronary stenting without balloon predilation in acute coronary syndromes. Am Heart J. 1999 Jul;138(1 Pt 1):55–59. doi: 10.1016/s0002-8703(99)70246-2. [DOI] [PubMed] [Google Scholar]
  7. Herz I., Assali A., Solodky A., Shor N., Ben-Gal T., Adler Y., Birnbaum Y. Coronary stent deployment without predilation in acute myocardial infarction: a feasible, safe, and effective technique. Angiology. 1999 Nov;50(11):901–908. doi: 10.1177/000331979905001104. [DOI] [PubMed] [Google Scholar]
  8. Herz I., Assali A., Solodky A., Shor N., Pardes A., Ben-Gal T., Adler Y. Effectiveness of coronary stent deployment without predilation. Am J Cardiol. 1999 Jul 1;84(1):89-91, A8. doi: 10.1016/s0002-9149(99)00198-8. [DOI] [PubMed] [Google Scholar]
  9. Laskey W. K., Brady S. T., Kussmaul W. G., Waxler A. R., Krol J., Herrmann H. C., Hirshfeld J. W., Jr, Sehgal C. Intravascular ultrasonographic assessment of the results of coronary artery stenting. Am Heart J. 1993 Jun;125(6):1576–1583. doi: 10.1016/0002-8703(93)90743-s. [DOI] [PubMed] [Google Scholar]
  10. Nakamura S., Colombo A., Gaglione A., Almagor Y., Goldberg S. L., Maiello L., Finci L., Tobis J. M. Intracoronary ultrasound observations during stent implantation. Circulation. 1994 May;89(5):2026–2034. doi: 10.1161/01.cir.89.5.2026. [DOI] [PubMed] [Google Scholar]
  11. Pentousis D., Guérin Y., Funck F., Zheng H., Toussaint M., Corcos T., Favereau X. Direct stent implantation without predilatation using the MultiLink stent. Am J Cardiol. 1998 Dec 15;82(12):1437–1440. doi: 10.1016/s0002-9149(98)00683-3. [DOI] [PubMed] [Google Scholar]
  12. Rogers C., Parikh S., Seifert P., Edelman E. R. Endogenous cell seeding. Remnant endothelium after stenting enhances vascular repair. Circulation. 1996 Dec 1;94(11):2909–2914. doi: 10.1161/01.cir.94.11.2909. [DOI] [PubMed] [Google Scholar]
  13. Ryan T. J., Faxon D. P., Gunnar R. M., Kennedy J. W., King S. B., 3rd, Loop F. D., Peterson K. L., Reeves T. J., Williams D. O., Winters W. L., Jr Guidelines for percutaneous transluminal coronary angioplasty. A report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Subcommittee on Percutaneous Transluminal Coronary Angioplasty). Circulation. 1988 Aug;78(2):486–502. doi: 10.1161/01.cir.78.2.486. [DOI] [PubMed] [Google Scholar]
  14. Topol E. J., Yadav J. S. Recognition of the importance of embolization in atherosclerotic vascular disease. Circulation. 2000 Feb 8;101(5):570–580. doi: 10.1161/01.cir.101.5.570. [DOI] [PubMed] [Google Scholar]
  15. Wilson S. H., Berger P. B., Mathew V., Bell M. R., Garratt K. N., Rihal C. S., Bresnahan J. F., Grill D. E., Melby S., Holmes D. R., Jr Immediate and late outcomes after direct stent implantation without balloon predilation. J Am Coll Cardiol. 2000 Mar 15;35(4):937–943. doi: 10.1016/s0735-1097(99)00639-7. [DOI] [PubMed] [Google Scholar]

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