Intraarterial pressure gradients after randomized angioplasty or stenting of iliac artery lesions. Dutch Iliac Stent Trial Study Group.

PURPOSE: To determine initial technical results of percutaneous transluminal angioplasty (PTA) and stent procedures in the iliac artery, mean intraarterial pressure gradients were recorded before and after each procedure. METHODS: We randomly assigned 213 patients with typical intermittent claudication to primary stent placement (n = 107) or primary PTA (n = 106), with subsequent stenting in the case of a residual mean pressure gradient of > 10 mmHg (n = 45). Eligibility criteria included angiographic iliac artery stenosis (> 50% diameter reduction) and/or a peak systolic velocity ratio > 2.5 on duplex examination. Mean intraarterial pressures were simultaneously recorded above and below the lesion, at rest and also during vasodilatation in the case of a resting gradient < or = 10 mmHg. RESULTS: Pressure gradients in the primary stent group were 14.9 +/- 10.4 mmHg before and 2.9 +/- 3.5 mmHg after stenting. Pressure gradients in the primary PTA group were 17.3 +/- 11.3 mmHg pre-PTA, 4.2 +/- 5.4 mmHg post-PTA, and 2.5 +/- 2.8 mmHg after selective stenting. Compared with primary stent placement, PTA plus selective stent placement avoided application of a stent in 63% (86/137) of cases, resulting in a considerable cost saving. CONCLUSION: Technical results of primary stenting and PTA plus selective stenting are similar in terms of residual pressure gradients.