Clinical Investigations: Interventional CardiologyCould direct stenting reduce no-reflow in acute coronary syndromes? A randomized pilot study☆,☆☆
Section snippets
Study design
This randomized study was designed to detect a reduction in the incidence of no-reflow after direct stenting with comparison with conventional stenting in the treatment of acute coronary syndrome-related lesions. From an observational study previously published,5 we hypothetized that in acute coronary syndromes the incidence of no-reflow in this high risk population could be reduced from 18% to 2% with direct stenting. The primary end point was the reduction of the no-reflow defined below. We
Clinical and angiographic characteristics
One hundred and thirty patients with a mean age of 61 ± 13 years (range, 36 to 84 years) were studied. These selected patients represented 34% of all patients treated with percutaneous transluminal coronary angioplasty and stent for an acute coronary syndrome during the same period in our center. Indications for angioplasty were recent myocardial infarction in 61% (63% acute infarction <12 hours) and unstable angina in 39% of the cases. Thrombolysis was performed in 37% of the patients with
Discussion
In this study, we showed that in a highly selected population direct stenting is a safe and economic strategy in acute coronary syndrome-related lesions. No significant effect was found concerning the reduction of the no-reflow phenomenon as shown with the TIMI flow grade and the comparison of the CTFC.
Recent improvements in stent implantation with high-pressure stent deployment17 and combinations of antiplatelet agents18 have led to a dramatic improvement in success rates, justifying the use
Acknowledgements
We thank Pierre Rayroles, General Director of the University Hospital of Caen, for his great support in the development of this study.
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2009, American Heart JournalCitation Excerpt :In almost all trials evaluating the efficacy of thrombus aspiration devices, the rate of direct stenting is much higher in patients with this pretreatment than in those with PCI only, even in subgroups with nonocclusive thrombus. It has been suggested that direct stenting without predilatation may decrease embolization and the incidence of the no-reflow phenomenon.26,27 What the respective role of direct stenting and thrombus aspiration is in the improvement of myocardial reperfusion needs further investigations.
Comparison of Outcomes of Direct Stenting Versus Stenting After Balloon Predilation in Patients With Acute Myocardial Infarction (DIRAMI)
2007, American Journal of CardiologyCitation Excerpt :For correct assessment of direct stenting and to avoid potential bias due to subjective selection of patients suitable for direct stenting, the randomization procedure was performed before coronary angiography. Due to broad inclusion criteria, early randomization, assessment of myocardial reperfusion, and 12-month angiographic and 5-year clinical follow-ups, our study addresses most issues raised by previous reports.1–4,6,11 Conversely to these studies, we did not exclude patients with small vessels, persistent TIMI grade 0 or 1 flow, massive coronary thrombus, vessel calcifications, or tortuosity.
Intracoronary thrombectomy with the Export Aspiration Catheter before angioplasty in patients with ST-segment elevation myocardial infarction
2007, Annales de Cardiologie et d'Angeiologie
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Reprint requests: Martial Hamon, MD, Service des Maladies du Cœur et des Vaisseaux, Centre Hospitalier Universitaire de Caen, Côte de Nacre, 14033 Caen, France.
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E-mail: [email protected]