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Background: Direct coronary stenting has been shown to be safe and feasible, with a demonstrable reduction in cost, procedural time and radiation exposure. Direct stenting may limit distal embolization of atherosclerotic plaque and consequently reduce myocardial cell injury following percutaneous coronary intervention, which may have important prognostic implications., Methods and Results: We assessed cardiac troponin I (cTnI) release in the 24 hours following direct coronary stenting (DS) as compared to stenting with balloon predilatation (PD) in a total of 311 patients and 440 vessels/lesions (vessel to lesion ratio = 1:1) (DS: n = 107 patients and 149 vessels/lesions; PD: n = 204 patients and 291 vessels/lesions). The 2 groups were well matched except for a greater proportion of diabetic patients in the PD group (21%) compared to the DS group (11%) (p < 0.05). There were no significant differences in the distribution of target lesion site or angiographic complexity between the 2 groups. Primary angiographic success was achieved in 97% of vessels in the DS group and 98% of vessels in the PD group (p = NS). DS failed in 7/114 patients (6%) deemed suitable for DS by the operator, but all stents were subsequently successfully deployed following balloon predilatation. Abciximab (ReoPro , Eli Lilly Company, Indianapolis, Indiana) was used in 11 patients (10%) in the DS group and 24 patients (12%) in the PD group ( p = 0.68). The post-procedural median (IQR) peak cTnI concentrations were 0.2 0.1 g/L in the DS group and 0.5 0.3 g/L in the PD group (p = 0.02). Post-procedural cTnI concentrations were > 0.2 g/L in 11 patients (10%) in the DS group and in 53 patients (26%) in the PD group (X2 = 58.6; p < 0.0001). The rate of major adverse cardiac events at 6 18 month follow-up was 8% in the DS group and 15% in the PD group (X2 = 38.5; p = 0.02)., Conclusion: Direct stenting without balloon predilatation is associated with lower post-procedural cTnI concentrations and lower incidence of major adverse events compared to traditional stenting with predilatation.

BACKGROUND: Currently little data exists on the use of single intracoronary stents for the treatment of long coronary artery lesions. The aim of this study was to evaluate the 18 mm Palmaz-Schatz stent (PS no. 204C) for the primary treatment of native coronary lesions between 15 mm and 18 mm in length. METHODS: A consecutive group of 17 patients were included in this study over a 3 month period. Each patient selected was felt suitable for elective treatment with an intracoronary stent and had a coronary artery lesion of >15 mm in length. Coronary arteriograms recorded just before PTCA, after full stent deployment and electively at 4 months after stent deployment were analyzed using semi-quantitative coronary angiography. RESULTS: Mean lesion length treated was 16.9 mm. The primary success rate for stent delivery was 16 out of 17 lesions. One patient required immediate coronary artery bypass surgery for extensive dissection of the right coronary artery. There were no out of hospital complications and no patient suffered acute or subacute stent thrombosis. All patients had an improvement in their Canadian Cardiovascular Angina Class: Three patients (21%) had asymptomatic restenosis (stenosis 50%) at follow-up angiography. CONCLUSION: This study shows the 18mm Palmaz-Schatz stent is relatively successful for the elective treatment of long coronary artery stenoses. Although the mean lesion length of 16.9 mm in this study is significantly greater than that of the BENESTENT and STRESS studies, the 21% restenosis rate is comparable.

BACKGROUND: Percutaneous transluminal coronary angioplasty is associated with higher rates of acute complications and restenosis when performed in the clinical setting of unstable angina. Coronary stent insertion has been shown to reduce restenosis when performed electively. The effect of unstable angina on clinical outcome after stent deployment is currently unclear. OBJECTIVE: To compare the clinical outcome after coronary stents inserted in patients with unstable and stable angina. DESIGN: A retrospective analysis of all patients receiving Palmaz-Schatz stents electively or for sub-optimal angioplasty result in patients with stable and unstable angina. PATIENTS: One-hundred fifty-seven patients received 178 Palmaz-Schatz stents electively or for the treatment of sub-optimal result. Thrombolysis in Myocardial Infarction Study (TIMI) grade 3 flow was present in all patients at the time of stent delivery. Unstable angina was defined as pain at rest despite anti-anginal therapy (Braunwald class II, III). Eighty-three patients (mean age 58 years) with unstable angina received 95 stents and 74 patients (mean age 57 years) with stable angina received 83 stents. MAIN OUTCOME MEASURES: Subacute stent thrombosis (SAST), myocardial infarction (MI), need for repeat angiography, coronary bypass graft surgery (CABG) and death. RESULTS: The early complications (within 2 weeks) comparing the unstable and stable groups respectively were: No deaths, SAST 3/83 (3.6%) vs. 2/74 (2.7%), MI 2/83 (2.4%) vs. 2/74 (2.7%) and CABG 6/83 (7.2%) vs. 2/74 (2.7%). After 2 weeks no patient had a MI or CABG. Clinical follow-up was continued up to 6 months. Two patients in each group had repeat angiography for recurrent symptoms. One patient in the stable group died from non-cardiac causes. CONCLUSIONS: There appears to be no difference in the early or late clinical outcome of patients with unstable or stable angina treated with coronary stent insertion when TIMI flow is normal at the time of stent insertion.

Background: Coronary stents may be used electively during percutaneous transluminal coronary angioplasty (PTCA) or as a "bail-out" device to treat abrupt or threatened vessel closure following PTCA., Objective: To compare the clinical outcome of elective and "bail-out" coronary stent insertion., Design: A retrospective analysis of all patients receiving coronary stents., Setting: Tertiary referral center performing over 400 PTCA procedures a year., Patients: Fifty-six patients (42 male), mean age 57 (range = 32 to 78) years received 67 Palmaz-Schatz coronary stents. Forty-nine stents were deployed as "bail-out" in 41 patients (abrupt vessel closure in 15 and threatened vessel closure in 26) and 18 stents were deployed electively in 15 patients., Main Outcome Measures: Myocardial infarction, repeat angiography, coronary artery bypass graft surgery and death., Results: Stents were successfully deployed in 56/62 (90.3%) patients. In-hospital events were significantly more common in the "bail-out" group compared to the elective group. The in-hospital events, comparing the "bail-out" group versus the elective group, were as follows: Death 2/41 (4.9%) vs 0/15 (0%), coronary artery bypass graft surgery (CABG) 8/41 (19.5%) vs 0/15 (0%), stent thrombosis 3/41 (7.3%) vs 0/15 (0%), and myocardial infarction 6/41 (14.6%) vs 1/15 (6.7%) respectively. After discharge no patient died or had CABG. One patient in the "bail-out" group had a myocardial infarct (late stent thrombosis). Two patients from each group had repeat angiography because of recurrent angina in the 6 month follow up period., Conclusion: "Bail-out" stenting has an increased incidence of in-hospital complications compared to elective procedures. If these short-term problems can be overcome however, the clinical events in the first 6 months after leaving hospital are low and similar to patients under-going elective procedures.