Safety, feasibility, and six-month outcomes of a systematic strategy of direct coronary stenting by a transradial approach in patients with single-vessel disease.

BACKGROUND: Strategies for percutaneous coronary intervention are continuously evolving, in order to reduce complications and to warrant better immediate and long-term outcomes. We sought to evaluate the safety, feasibility, and long-term outcomes of a systematic strategy of coronary stenting without predilation (direct stenting) via a transradial approach for single-vessel procedures.

METHODS: Stenting was performed with Snapper stent and wide inner-lumen, preformed, guiding catheters; 118 minimally-selected patients (59% of all single-vessel procedures performed at our center during the study period) were enrolled: among them 39% presented for acute coronary syndromes, 28% were under glycoprotein IIb/IIIa inhibitor treatment, and 10% had a poor left ventricular function; 130 lesions were treated (1.1 stents/lesion): 53% were type B2/C, 8% longer than 20 mm, and 16% on bifurcations.

RESULTS: The transradial approach was successful in 96% of cases; 7% required predilation. The immediate angiographic and clinical success rates were 100 and 98% respectively. No bleeding complications occurred when the transradial approach was successful. At 6 months, the mortality, major adverse events, recurrent ischemia, and target lesion revascularization rates were 0, 14, 15, and 10% respectively.

CONCLUSIONS: A systematic strategy of direct stenting via a transradial approach for single-vessel procedures seems safe, feasible, and efficacious both immediately, and at 6 months of follow-up, even when treating complex lesions and/or high-risk patients.