Angiographic, intravascular ultrasound, and fractional flow reserve evaluation of direct stenting vs. conventional stenting using BeStent2 in a multicentre randomized trial

Aims: Direct stenting (DS) may not be as safe and effective as conventional stenting. The objective was to demonstrate equivalence of post-procedural mean luminal diameter (MLD) by angiography after BeStent2 placement between DS and pre-dilatation (PD) strategy. Methods and results: Two hundred and two patients with a single de novo lesion (diameter ≥3.0 mm and length ≤13 mm) were randomized to DS (n = 101) vs. PD. Stent deployment was guided by on-line quantitative coronary angiography (QCA). A second randomization assigned half of the patients to intravascular ultrasound (IVUS) and fractional flow reserve (FFR) assessment. QCA was repeated at 6 months. Baseline characteristics were similar. Crossover to PD was necessary in seven DS patients. Stent deployment was successful in 97% (DS) and 98% (PD). The post-procedural MLD was 2.79 ± 0.45 mm (DS) and 2.76 ± 0.40 mm (PD). The null-hypothesis of non-equivalence could be rejected (95% one-sided; P = 0.0003). The minimum stent area (IVUS) was 7.89 ± 1.75 mm2 (DS) and 8.07 ± 2.37 mm2 (PD; P = 0.69), with an FFR of 0.92 ± 0.07 and 0.92 ± 0.05, respectively (P = 0.97). Major adverse cardiac event rates at 6 months were 9% (DS) and 11% (PD; P = 0.93). Target lesion re-angioplasty was 6% (DS) and 5% (PD; P = 0.77). The in-stent restenosis rate by QCA was 7.4% (DS) and 6.8% (PD; P = 0.87). Conclusion: DS with BeStent2 is equivalent to PD. Both strategies resulted in a low angiographic restenosis rate.

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