title: Stent placement after iliac angioplasty: comparison of hemodynamic and angiographic criteria. Dutch Iliac Stent Trial Study Group.
abstract: OBJECTIVE
  To assess the diagnostic value of angiography as a guideline for selective stent placement after percutaneous transluminal angioplasty (PTA) of the iliac artery.
  
  
  METHODS
  Seventy-nine patients (100 iliac artery lesions) with intermittent claudication were treated with PTA and stent placement if they had a residual intraarterial mean pressure gradient of more than 10 mm Hg across the PTA site. Pre- and post-PTA angiograms were used to determine if stent placement was necessary for improvement of the initial result of PTA. Interobserver agreement was determined by using kappa statistics. Pearson correlation coefficients for the percentage of residual stenosis and the pressure gradient after angioplasty were calculated. Sensitivity and specificity of angiography with regard to secondary stent placement were calculated.
  
  
  RESULTS
  Observer agreement on stenosis grade before angioplasty was good (mean kappa, 0.65). Agreement on angioplasty results was fair (mean kappa, 0.45). Agreement on selective stent placement on the basis of angiographic criteria was poor to fair (kappa = 0.21-0.62). Correlation between percentage stenosis and pressure gradient was low (Pearson coefficient, 0.01-0.17). The sensitivity and specificity of angiography were 45% and 63%, respectively.
  
  
  CONCLUSIONS
  Angiography is inadequate for determination of a suboptimal angioplasty result. The decision to perform selective stent placement should be made on the basis of hemodynamic measurements.
authors.affiliation: Department of Radiology, University Hospital Utrecht, The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: Tetteroo
authors.forename: A D
authors.initials: AD
authors.lastname: van Engelen
authors.forename: J H
authors.initials: JH
authors.lastname: Spithoven
authors.forename: A V
authors.initials: AV
authors.lastname: Tielbeek
authors.forename: Y
authors.initials: Y
authors.lastname: van der Graaf
authors.forename: W P
authors.initials: WP
authors.lastname: Mali
mesh_terms: D015901:Angiography, Digital Subtraction; D000800:Angioplasty, Balloon; D001161:Arteriosclerosis / Q000000981:diagnostic imaging / Q000628:therapy*; D001794:Blood Pressure / Q000502:physiology; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000628:therapy; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D007383:Intermittent Claudication / Q000000981:diagnostic imaging / Q000628:therapy*; D015588:Observer Variation; D012680:Sensitivity and Specificity; D015607:Stents