THERAPEUTIC CONSEQUENCES OF VARIATION IN INTRAARTERIAL PRESSURE MEASUREMENTS AFTER ILIAC ANGIOPLASTY

Purpose: To assess the accuracy of intraarterial measurement of transs tenotic pressure gradients for the detection of hemodynamically subopt imal iliac angioplasty. Methods: In 14 patients, referred for diagnost ic angiography, mean pressure gradients in the aorta and iliac artery were obtained twice, using a double-sensor pressure catheter. Addition al iliac measurements were performed during pharmacologically induced flow augmentation. Repeatability was assessed by calculation of the me an difference plus standard deviation (MD +/- SD) and repeatability co efficient (2 x SD). These results were extrapolated to 137 iliac angio plasty procedures with secondary stenting where there was a residual p ressure gradient > 10 mmHg. Results: MD +/- SD for repeated measuremen ts at rest and during flow augmentation were 0 +/- 2 mmHg and 1 +/- 3 mmHg, respectively. Repeatability coefficients were 3 and 6 mmHg. Mean pressure gradients after hemodynamically insufficient angioplasty wer e 8 +/- 7 mmHg at rest and 17 +/- 5 mmHg following vasodilatation. Ina ccurate pressure recordings may have led to inappropriate stent placem ent in less than 2.5%, and inappropriate denial of stent placement in less than 5% of the lesions. Conclusion: Variability of intraarterial pressure measurements has little consequence in the detection of hemod ynamically significant stenosis after angioplasty.