Journal Article

Comparative Effectiveness of Peripheral Angioplasty Strategies for 1-Year Restenosis in Lower Limb Artery Disease: A Retrospective Single-Center Analysis

Garot, Philippe, Lounes, Youcef, Sanguineti, Francesca, D’Angelo, Livio, Hovasse, Thomas, Benamer, Hakim, Sayah, Neila, Laforgia, Pietro, Neylon, Antoinette, Akodad, Mariama, Amabile, Nicolas, Champagne, Stephane, Unterseeh, Thierry, Skalidis, Ioannis, Honton, Benjamin, Sauguet, Antoine

2025

Overview

Background: Optimal endovascular strategy for lower limb peripheral artery disease (PAD) remains debated, particularly regarding 1-year restenosis. Aim: To evaluate the association between drug-coated balloon (DCB)-based angioplasty and 1-year restenosis compared with stent-based and plain balloon strategies in a real-world PAD cohort. Methods: We performed a single-center retrospective analysis of 283 consecutive patients (mean age 67.5 ± 11.2 years, 79% male) undergoing lower limb angioplasty between 2010 and 2023. Patients were treated with one of five strategies: direct stent, pre-dilatation + stent, stent + post-dilatation, DCB ± bailout stent, or plain old balloon angioplasty (POBA). Restenosis at 12 months (≥50% diameter reduction on Doppler, CT angiography, or angiography) was the primary endpoint. Kaplan-Meier curves and multivariable Cox regression adjusted for clinical and lesion characteristics were used. The prespecified main comparison was DCB ± stent versus non-DCB strategies. Results: Overall, 1-year restenosis occurred in 81 patients (28.7%). Restenosis rates were 15.4% with DCB ± stent versus 34.2%, 29.8%, 31.5%, and 38.1% with direct stent, pre-dilatation + stent, stent + post-dilatation, and POBA, respectively (p = 0.004). In adjusted analysis, DCB ± stent was associated with a lower hazard of restenosis compared with direct stent (HR 0.52; 95% CI 0.31–0.87), whereas POBA was associated with a higher hazard versus DCB ± stent (HR 1.89; 95% CI 1.01–3.53). Periprocedural complication rates were low and similar across groups (overall 6.3%). Conclusions: In this real-world PAD cohort, DCB-based angioplasty was independently associated with lower 1-year restenosis compared with stent-based and plain balloon strategies, without an excess of procedural complications. Given the observational design and lesion-driven strategy selection, these findings should be interpreted as hypothesis-generating but support broader use of DCB in appropriately selected lesions.

• Publisher: MDPI AG
• Subject: Angiography / Angioplasty / Balloon treatment / Calcification / Cardiac patients / Cardiovascular system / Care and treatment / Diabetes / Diagnostic imaging / Diseases / Dissection / Drug dosages / drug-coated balloon / endovascular therapy / femoropopliteal angioplasty / France / Implants / Kidney diseases / Lesions / Medical imaging / Morphology / Optimization techniques / peripheral artery disease / Pseudoaneurysm / Restenosis / Stent (Surgery) / Stents / Success / Transluminal angioplasty / Ultrasonic imaging / Variance analysis / Vascular diseases / Vein & artery diseases