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Determination of Renal Arterial Stenosis Severity: Comparison of Pressure Gradient and Vessel Diameter¹

¹ From the Franz Volhard Clinic, Max Delbrück Center for Molecular Medicine, Charité, Humboldt University of Berlin, Wiltbergstrasse 50, 13125 Berlin, Germany. Received August 25, 2000; revision requested October 4; final revision received February 12, 2001; accepted March 2. Address correspondence to C.M.G. (e-mail: gross@fvk-berlin.de).

PURPOSE: To determine the hemodynamic significance of arteriographically detected renal arterial stenosis by obtaining pressure gradients with a miniaturized pressure guide wire.

MATERIALS AND 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 µmol/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.

CONCLUSION: 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.

Index terms: Renal angiography, 961.122 • Renal arteries, stenosis or obstruction, 961.72 • Renal arteries, US, 961.12984, 961.12989

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