| Objective: In this randomized study, direct stenting without balloon predilation and percutaneous angioplasty (PTCA)/stenting were performed respectively to the senior patients with coronary heart disease (CHD) who are older than 65 years to compare the indications, complications, short term and long term effect of the two methods of percutaneous coronary intervention (PCI), discuss the feasibility and safety of direct stenting and provide more rational strategy of percutaneous coronary intervention for the elderly.Methods: From January 2001 to June 2002, 70 patients were enrolled in our study according to the following terms: aged from 65 to 75 years; proved coronary heart disease patients by coronary angiography (CAG); type A or type B1 lesions. stenosis from 75%-95%. In these 70 patients, there were 44 male patients and 26 female patients and the mean years was 68.95±3.42. The patients with left main (LM) lesions, intro-stent restenosis lesions,serious calcified lesions serious eccentric lesions and serious angulationlesions were excluded. Patients with clinical evidence of cardiac shock, medium or serious insufficiency of renal function, serious valvular heart disease, dilated cardiomyopathy, hyperchophic cardiomyopathy, contra-indications of anticoagulation therapy were also excluded. These 70 cases were randomizedly divided into direct stenting group(DS group, n=37, 23 males,14 females, mean years was 69.41±3.27)and PTCA/stenting group (CS group, n=33, 21 males,12 females, mean years was 68.5±3.56). In the procedure of PTCA/stenting, the lesions were predilated with balloon and then the stents were released. While in the direct stenting group, the lesions was not predilated with balloon .On the contrary, the stents was dilated directly and covered the lesion according the diameter of reference vessels, the stenosis degree and the length of the lesions. If the stent covered the lesion satisfactorily and was delivered completely ,there was no dissection and blood flow is TIMI 3 grade, we thought the procedure was successful .Quantitative coronary angiography(QCA) analysis was performed before and after the procedure, the minimal lumen diameter(MLD)was measured, acute gain(AG) was calculated and the maximal dilation pressure, procedure time, radiation exposure time, the amount of contrast dye used, PCI cost and complications were wrote down. After PCI, six months follow up were given to all of the 70 patients. The contents of follow upinclude acute or subacute intra-stent thrombosis, recurrent angina pectoris, acute myocardial infarction, revascularizition, coronary by-pass and death. Six months after the percutaneous coronary intervention, the follow-up CAG was performed again and the minimal lumen diameter of the old lesions were measured by QCA, and late loss (LL) and net gain (NG) were calculated.Results: There was no significant difference between the mean years, sex, risk factors of coronary heart disease, heart function, stenosis degree, distribution of lesions and lesion types of the two groups. There were 3 patients in the PTCA/stenting group and 1 patient in the direct stenting group who had dissection at the distal vessel of the stent after percutaneous coronary intervention. All of the 4 lesions were covered satisfactorily after another stent were given. In the PTCA/stenting group, acute renal failure accured in 1 patient. While in the DS group, there was no renal failur happened. So the complication rate of DS group is lower than that of CS group (2.7% vs 12.1%). In the PTCA/stenting group, one patient had no-reflow with TIMI 1 grade flow. After nitroglycerin and diltiazem were injected into coronary, the blood flow reached TIMI 2 grade. In the direct stenting group, there was no no-reflow happened, but there was one stent shed when it was crossing the lesion. After the stent was reclaimed successfully, another stent was dilated successfully. Also one stent was incompletelydelivered with in-print because of the hard plaque. After high pressure dilation...
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