ABSTRACT
The implantation technique for direct stenting is not dissimilar to standard techniques for stent deployment, except that there is no balloon predilatation. Standard guide catheters and guidewires have been used in the published trials. In many of the published studies from the early 1990s, 8 Fr guide catheters were used. More recently, there has been a shift towards 6 Fr guide catheters via the femoral artery and 5-Fr via the radial artery. Although the initial series utilized a protected over-the-wire system, this rapidly evolved to the unprotected rapidexchange system. With newer stent delivery systems, the risk of stent dislodgement has been minimized. Maximal guide catheter support is, however, crucial for this technique. As the antegrade flow (due to the larger profile) is often abolished as soon as the stent delivery unit is located in the stenotic area, auxiliary landmarks for accurate placement are important. These must be identified prior to advancing the stent to the lesion.
