Impact of different hemodynamic criteria for stent placement after suboptimal iliac angioplasty. Dutch Iliac Stent Trial Study Group.
OBJECTIVE
To investigate the consequences of different hemodynamic criteria as indications for stent placement after suboptimal iliac angioplasty.


METHODS
One hundred thirty-six patients with intermittent claudication, on the basis of atherosclerotic disease of the iliac artery, underwent angioplasty. Intraarterial systolic and mean pressures were simultaneously recorded above and below the lesion, with and without vasodilation, and before and after percutaneous angioplasty. These data were used to estimate what proportion of the study population would be eligible for stent placement according to different criteria reported in the literature. Subsequently, the authors compared peak systolic velocity (PSV) ratios during follow-up in their patients, with and without indication for stent placement according to two different criteria.


RESULTS
Applying the different thresholds reported in the literature to the patient group shows that stent placement would be indicated in anywhere from 4% to 87% of cases. No difference was observed when PSV ratios were compared in patients with a residual mean pressure gradient of > or = 5 and < or = 10 mm Hg with patients with a residual mean pressure gradient of less than 5 mm Hg.


CONCLUSIONS
Application of the various published thresholds as indications for secondary stent placement leads to a wide range in proportion of cases requiring stent placement. Lesions with a residual mean pressure gradient of > 5 and < 10 mm Hg fare as well as lesions with a residual mean pressure gradient of less than 5 mm Hg. The optimal criterion is still not clear.
Department of Radiology, Red Cross Hospital Beverwijk, The Netherlands.
A G
AG
Kamphuis
A D
AD
van Engelen
E
E
Tetteroo
M G
MG
Hunink
W P
WP
Mali
D000800:Angioplasty, Balloon; D001161:Arteriosclerosis / Q000628:therapy*; D001783:Blood Flow Velocity / Q000502:physiology; D001794:Blood Pressure / Q000187:drug effects; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007083:Iliac Artery / Q000187:drug effects / Q000473:pathology*; D007383:Intermittent Claudication / Q000628:therapy; D007511:Ischemia / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000628:therapy*; D015607:Stents; D014665:Vasodilator Agents / Q000627:therapeutic use
D014665:Vasodilator Agents