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Saphenous vein graft stenting without predilation may potentially decrease procedural complications such as distal embolization and no-reflow phenomenon. In this report the authors describe the deployment of stents (three Wallstents, one Palmaz-Schatz, one Multilink, and one NIR) without predilation in five patients with unstable angina pectoris due to high-grade stenosis in old saphenous vein grafts. Stent deployment was successful in all patients without procedure-related complications. Stenting without predilation appears to be feasible in old bypass grafts with significant stenosis. The potential of this new stenting technique to reduce the risk of stenting complications should be tested by a randomized trial.

Direct percutaneous transcatheter revascularization (PTCR) is becoming an acceptable therapy for acute myocardial infarction (AMI). Stenting in the setting of AMI, once consid ered contraindicated, is emerging as a suitable option in this situation. Coronary stenting without predilation (SWOP) may potentially shorten the procedure and radiation time, reduce costs, and decrease procedural complications such as coronary dissection and distal embolization. It is expected to cause less vascular injury, with a reduction in the rate of in-stent restenosis. In this preliminary study the authors evaluated the feasibility of the SWOP procedure in 22 selected patients with AMI. Indications for catheter-based myocardial reperfusion were the following: extensive anterior wall MI (68%), inferior wall and right ventricular MI (23%), and inferior wall MI with contraindication for thrombolytic therapy (9%). Patients with cardiogenic shock or with contraindications for aspirin or ticlopidine were excluded. SWOP was successful in 21 attempts (95%), and final procedural success was achieved in all. Proximal or distal dissections were seen in three cases and were treated by additional three stents. Thrombolysis in myocardial infarction (TIMI) flow 3 was restored in all patients. There were no distal embolizations, side branch occlusions, coronary perforations, procedure-related emergency bypass operations, or deaths. It is concluded that in selected patients with AMI, coronary artery stenting without predilation is feasible and safe and does not introduce additional risk to the patients.

The authors report the implantation of two wallstents in a patient by use of the transra dial artery approach. This approach for coronary wallstent implantation allows for intensive anticoagulation therapy with less risk of bleeding.