STENT PLACEMENT AFTER ILIAC ANGIOPLASTY - COMPARISON OF HEMODYNAMIC AND ANGIOGRAPHIC CRITERIAL

PURPOSE: To assess the diagnostic value of angiography as a guideline for selective stent placement after percutaneous transluminal angiopla sty (PTA) of the iliac artery. MATERIALS AND METHODS: Seventy-nine pat ients (100 iliac artery lesions) with intermittent claudication were t reated with PTA and stent placement if they had a residual intraarteri al mean pressure gradient of more than 10 mm Hg across the PTA site. P re-and post-PTA angiograms were used to determine if stent placement w as necessary for improvement of the initial result of PTA. Interobserv er agreement was determined by using kappa statistics. Pearson correla tion coefficients for the percentage of residual stenosis and the pres sure gradient after angioplasty were calculated. Sensitivity and speci ficity of angiography with regard to secondary stent placement were ca lculated. RESULTS: Observer agreement on stenosis grade before angiopl asty was good (mean kappa, 0.65). Agreement on angioplasty results was fair (mean kappa, 0.45). Agreement on selective stent placement on th e 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. CONCLUSION: Angiography is inadequate for determination of a suboptimal angioplasty result. The decision to perform selective stent placement should be made on the ba sis of hemodynamic measurements.