A randomized comparison of direct stenting versus stenting with predilatation in native coronary artery disease: Results from the multicenter CROSSCUT study

Flavio Airoldi, Carlo Di Mario, Giorgio Gimelli, Antonio L. Bartorelli, Francesco Bedogni, Carlo Briguori, Arian Frasheri, Luigi Inglese, Nino Rubino, Angela Ferrari, Bernhard Reimers, Antonio Colombo

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Abstract

Stenting without predilatation has become possible due to the availability of a new generation of flexible, low-profile, securely crimped, balloon-expandable stents. This study compared the feasibility, efficacy and cost-effectiveness of direct stenting (DS) to the standard predilatation technique (PS) using the premounted Crossflex LC stent (Cordis Corporation, Miami Lakes, Florida). The study is a randomized prospective multicenter evaluation including 271 patients (140 patients in the DS group and 131 patients in the PS group) with 1 or 2 de novo or restenotic lesions located in native coronary arteries. Procedural success was 98.9% and 98.7% in the DS and PS groups, respectively (p = NS); crossover to PS was required in 22/166 lesions (13.2%) enrolled in the DS group because of inability to cross the target lesion without predilatation. Nonsignificant reductions in procedural time (-10.5%), fluoroscopy time (-4.7%) and amount of contrast (-3.8%) were observed in the DS group in comparison to the PS group. The number of balloons used (-76.6%) and the global cost of the procedure (-18.8%) were significantly lower in the DS group (p <0.01 for both comparisons). After 6 months, no differences were observed in the restenosis rate between the two groups (22.0% for DS group versus 18.1% for PS group; p = NS) and in the incidence of major adverse clinical events (5.0% for DS group versus 3.0% for PS group; p = NS). Direct stenting is safe and feasible for the treatment of lesions in native coronary arteries and obtains a significant reduction in procedural cost, mainly due to the lower number of balloons used. Clinical and angiographic results at 6 months are comparable to those obtained after a conventional predilatation-stenting strategy.

Original languageEnglish
Pages (from-to)1-5
Number of pages5
JournalJournal of Invasive Cardiology
Volume15
Issue number1
Publication statusPublished - Jan 1 2003

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Keywords

  • Angioplasty
  • Coronary arteries
  • Direct stenting

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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