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Duplex ultrasonography in assessing restenosis of renal artery stents

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Abstract

Purpose: To determine the accuracy and optimal threshold values of duplex ultrasonography (US) in assessing restenosis of renal artery stents.

Methods: Twenty-four consecutive patients with 33 renal arteries that had previously been treated with placement of a Palmaz stent underwent duplex US prior to intraarterial digital subtraction angiography (DSA), which was the reference standard. Diagnostic accuracy of in-stent peak systolic velocity (PSV) and reno-aortic ratio (RAR=PSV renal stent/PSV aorta) in detecting τ; 50% in-stent restenosis were evaluated by the receiver operating characteristic curve. Sensitivity and specificity were determined using the optimal threshold values, and using published threshold values: RAR τ; 3.5 and in-stent PSV τ; 180 cm/sec.

Results: Six examinations were technically inadequate. Nine stents had residual or restenosis τ; 50% at DSA. The two duplex parameters were equally accurate since areas under the curves were similar (0.943). With optimal threshold values of 226 cm/sec for PSV and 2.7 for RAR, sensitivities and specificities were 100% and 90%, and 100% and 84%, respectively. Using the published duplex criteria resulted in sensitivities and specificities of 100% and 74% for PSV, and 50% and 89% for RAR.

Conclusion: Duplex US is a sensitive modality for detecting in-stent restenosis if laboratory-specific threshold values are used.

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  1. Jeannette Bakker

    Present address: Department of Radiology, University Hospital Rotterdam, c/o Dr. Molewaterplein, 3015 GD, Rotterdam, The Netherlands

Authors and Affiliations

  1. Department of Radiology, University Hospital Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands

    Jeannette Bakker, Otto E. H. Elgersma, Gérard A. P. de Kort & Frederik J. A. Beek

  2. Department of Nephrology, University Hospital Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands

    Jaap J. Beutler

  3. Department of Radiology, University of Virginia Health Sciences Center, 22908, Charlottesville, VA, USA

    Eduard E. de Lange

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Bakker, J., Beutler, J.J., Elgersma, O.E.H. et al. Duplex ultrasonography in assessing restenosis of renal artery stents. Cardiovasc Intervent Radiol 22, 475–480 (1999). https://doi.org/10.1007/s002709900435

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