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Direct stenting should be attempted by default whenever possible
  1. Iñigo Lozano,
  2. Pablo Avanzas,
  3. Juan Rondan
  1. Department of Cardiology, Hospital Central Asturias, Oviedo, Spain
  1. Correspondence to Dr Iñigo Lozano, 2132 Piles-Infanzon, Gijon 33203, Spain; inigo.lozano{at}

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To the Editor: We have read with interest the article by Piscione et al1 concerning direct stenting. The authors have performed a meta-analysis of 24 randomised controlled trials of direct stenting compared with stenting with predilatation, and the conclusion is a 23% reduction in the odds of myocardial infarction. In our opinion, direct stenting should be the approach of choice in all susceptible cases because this important benefit is not associated with an increase in mortality, re-stenosis or stent expansion,2 3 and also direct stenting saves time and significantly reduces procedural costs. In the current context with a strict reduction in economic resources, every approach directed to reduce costs should be attempted. A typical case of direct stenting can usually be performed with one guiding catheter, one coronary wire and one stent. In our country the use of one balloon will represent aproximately 28% of the cost of the procedure if the stent is bare metal and 20% if it is a drug-eluting stent. Few actions in medicine allow us to save such percentages with the same or even better results. Stent dislodgement is extremely rare with the current stent designs, and there are guiding catheters dedicated to accomplish active intubation that facilitate direct stenting. Moreover, if postdilatation needs to be performed to complete the procedure, new balloons that can be inflated up to 40 atmospheres can be found on the market. We believe that there are no arguments in favour of performing predilatation if direct stenting is potentially possible.


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  • Competing interests None declared.

  • Provenance and peer review Not commissioned; not externally peer reviewed.

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