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The Authors' reply: We thank Dr Lozano and coworkers1 for their interest in our article.2 We support the direct stenting technique as a safe and reliable solution for patients undergoing stenting in daily practice. Beside the reported clinical benefits, direct stenting can also be associated with less radiation exposure and lower contrast media use, saving more time than conventional stenting. Moreover, although in the present study we did not perform a cost-effectiveness analysis, it is arguable that a ‘one-device only’ strategy would be less costly than a strategy of predilation plus stenting, as we previously reported.3
Furthermore, for patients presenting with huge thrombotic lesions, such as those experiencing ST-elevated acute myocardial infarction, the direct stenting technique would be more beneficial, as a consequence of less coronary thrombus manipulation, less predilation-associated emboli dislodgement, thus providing final higher coronary as well as myocardial perfusional grades.
Unfortunately, only four trials among those included in our meta-analysis were performed in the acute coronary setting, limiting any conclusion about the usefulness of direct stenting in this field.
In this regard, large-scale randomised trials evaluating the impact of a direct stenting strategy compared with the conventional one in selected as well as complex scenarios are warranted.