Determination of renal arterial stenosis severity: comparison of pressure gradient and vessel diameter.
OBJECTIVE
To determine the hemodynamic significance of arteriographically detected renal arterial stenosis by obtaining pressure gradients with a miniaturized pressure guide wire.


METHODS
Forty-six renal arterial stenoses in 38 patients were assessed in terms of severity and then subjected to gradient determination before and after angioplasty. The patients (mean age, 63 years) had a mean serum creatinine value of 1.3 mg/dL +/- 0.4 (114.9 micromol/L +/- 35.4 [SD]) and required on average three medications for blood pressure control. The mean degree of stenosis diameter was 51% +/- 17 (range, 12%-85%).


RESULTS
The systolic and mean arterial pressure gradients with and those without vasodilatation were highly correlated with stenosis severity, systolic blood pressure, and serum creatinine as a curvilinear fit (r = 0.9, P <.01). At 50% stenosis severity, the mean pressure gradient was 22 mm Hg.


CONCLUSIONS
Patients with a pressure gradient greater than 20 mm Hg should be good candidates for renal arterial dilatation, and use of the pressure guide wire will facilitate interventional decisions.
Gross
C M
CM
Franz Volhard Clinic, Max Delbrück Center for Molecular Medicine, Charité, Humboldt University of Berlin, Wiltbergstrasse 50, 13125 Berlin, Germany. gross@fvk-berlin.de
Krämer
J
J
Weingärtner
O
O
Uhlich
F
F
Luft
F C
FC
Waigand
J
J
Dietz
R
R
D000328:Adult; D000368:Aged; D017130:Angioplasty; D001794:Blood Pressure; D003404:Creatinine / Q000097:blood; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D012077:Renal Artery / Q000473:pathology; D012078:Renal Artery Obstruction / Q000175:diagnosis*; D012720:Severity of Illness Index
D003404:Creatinine