In Reply to: Re: 597 06 -- Dissection after iliac stent placement posted by Scott Trerotola on May 23, 1997 at 08:49:29:
It is hard to say on a web page, but the contrast density of the post PTA angiogram looks fairly dense. A subtle flap could be missed if the contrast density is not adjusted during review of the images. I agree with Scott Trerotola that there probably would not have been much indication to stent further even if a subtle flap was seen since the gradient was reduced to a good level. Regarding IVUS, I presented a paper a few years ago at RSNA it which we compared angio and IVUS to a gold standard of pressure gradients in the iliacs. We found that IVUS is certainly more sensative, but almost too sensative. We were better able to predict if a lesion was going to have a pressure gradient by our angiographic assessments. With IVUS we rarely missed disease, but often over-estimated the potential for a significant gradient when making the call by IVUS.