Hubungan POBA dan Stent dengan Restenosis Enam Bulan pada Lesi Femoropopliteal dan Infrapopliteal Berdasarkan GLASS
DOI:
https://doi.org/10.36452/jkdoktmeditek.v32i5.4381Keywords:
Angioplasty, GLASS, Peripheral Arterial Disease, POBA, RestenosisAbstract
Introduction Peripheral arterial disease (PAD) is a systemic atherosclerotic condition that frequently requires endovascular revascularization. Post-angioplasty restenosis remains a major clinical challenge affecting mid-term outcomes. This study analyzed the association between the use of plain old balloon angioplasty (POBA) and stenting and 6-month restenosis in femoropopliteal and infrapopliteal lesions according to the GLASS classification. Methods: An analytical observational study with a retrospective cohort design was conducted using medical records of PAD patients who underwent angioplasty at RSCM between January 2019 and March 2026. A total of 243 patients met the inclusion criteria. Data were analyzed using the chi-square test or Fisher's exact test, applied according to which assumptions were met. Results: Restenosis occurred in 94 patients (38.7%). Age was significantly associated with restenosis (p=0.002), and lesion location was also significant (p=0.001), with restenosis occurring more frequently in infrapopliteal lesions. POBA use, stent use, and the total GLASS score were not significantly associated with restenosis (p=0.306, p=0.306, and p=0.929, respectively). In the location-stratified analysis, both the GLASS score and POBA use showed significant associations with restenosis (p=0.01), whereas stent use according to lesion location showed no significant association (p=1.00). Conclusions: In PAD patients undergoing angioplasty, lesion location and age are the dominant determinants of restenosis, outweighing procedural modality choice between POBA and stent placement.
References
1. Gornik HL, Aronow HD, Goodney PP, et al. 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline for the management of lower extremity peripheral artery disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2024.
DOI: https://doi:10.1161/CIR.0000000000001251.
2. Mazzolai L, Teixido Tura G, Lanzi S, et al. 2024 ESC Guidelines for the management of peripheral arterial and aortic diseases. Eur Heart J. 2024;45(36):3538-3700.
DOI : https://doi:10.1093/eurheartj/ehae179.
3. Criqui MH, Matsushita K, Aboyans V, et al. Lower extremity peripheral artery disease: contemporary epidemiology, management gaps, and future directions: a scientific statement from the American Heart Association. Circulation. 2021;144(9):e171-e191.
DOI : https://doi:10.1161/CIR.0000000000001005.
4. Okunlola AO, Ajao TO, Karim A, et al. A review of peripheral artery disease in diabetic patients in sub-Saharan Africa. Cureus. 2024;16(9):e69808.
DOI : https://doi:10.7759/cureus.69808.
5. Xu Y, Pouncey AL, Zhou Z, Woodward M, Harris K. Smoking as a risk factor for lower extremity peripheral artery disease in women compared to men: a systematic review and meta-analysis. PLoS One. 2024;19(4):e0300963.
DOI : https://doi:10.1371/journal.pone.0300963.
6. Böhme T, Zeller T. Endovascular therapy for peripheral artery disease. Herz. 2023;48(20):1301-1306.
DOI : https://doi:10.1055/a-2017-7786.
7. Wijnand JGJ, Zarkowsky D, Wu B, van Haelst STW, Vonken EPA, Sorrentino TA, et al. The Global Limb Anatomic Staging System (GLASS) for CLTI: improving inter-observer agreement. J Clin Med. 2021;10(16):3454.
DOI : https://doi:10.3390/jcm10163454.
8. Luan TMB, Tuong NH, Dang TN, et al. Validation of the global limb anatomical staging system in Vietnamese patients treated for chronic limb-threatening ischemia. CVIR Endovascular. 2024;7:25.
DOI : https://doi:10.1186/s42155-024-00433-x.
9. Zhang B, et al. Role of the Global Limb Anatomic Staging System in predicting outcomes of chronic limb-threatening ischemia in patients treated by drug-coated balloons. Ann Vasc Surg. 2023.
10. World Health Organization. Ageing and health [Internet]. Geneva: World Health Organization; 2025 [cited 2026 Jun)
11. Indonesia. Undang-Undang Republik Indonesia Nomor 13 Tahun 1998 tentang Kesejahteraan Lanjut Usia. Jakarta: Presiden Republik Indonesia; 1
12. Houghton JSM, Saratzis AN, Sayers RD, Haunton VJ. New horizons in peripheral artery disease. Age Ageing. 2024;53(6):afae114.
DOI : https://doi:10.1093/ageing/afae.
13. Fowkes FGR, Rudan D, Rudan I, Aboyans V, Denenberg JO, McDermott MM, et al. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: A systematic review and analysis. The Lancet. 2013.
DOI : https://doi.org/10.1016/S0140-6736(13)61249-0 PubMed PMID: 23915883.
14. Mensah GA, Fuster V, Murray CJL, Roth GA, Mensah GA, Abate YH, et al. Global Burden of Cardiovascular Diseases and Risks, 1990-2022. J Am Coll Cardiol. 2023;82(25).
DOI : https://doi:10.1016/j.jacc.2023.11.00.
15. Adou C, Magne J, Gazere N, Aouida M, Chastaingt L, Aboyans V. Global epidemiology of lower extremity artery disease in the 21st century (2000–21): a systematic review and meta-analysis. Eur J Prev Cardiol. 2024;31(7).
DOI : https://doi.org/10.1093/eurjpc/zwad381
16. Beckman JA, Schneider PA, Conte MS. Advances in Revascularization for Peripheral Artery Disease: Revascularization in PAD. Circ Res. 2021;128(12).
DOI : https://doi:10.1161/CIRCRESAHA.121.318261.
17. Farber A, Menard MT, Conte MS, Kaufman JA, Powell RJ, Choudhry NK, et al. Surgery or Endovascular Therapy for Chronic Limb-Threatening Ischemia. New England Journal of Medicine. 2022;387(25).
DOI : https://doi:10.1056/nejmoa2207899.
18. Shishehbor MH, Jaff MR. Percutaneous Therapies for Peripheral Artery Disease. Circulation. 2016;134(24).
DOI : https://doi:10.1161/CIRCULATIONAHA.116.022546.
19. Kuchay AA, Lipin AN, Padaria SF, Gruzdev NN, Borisov AG, Muhamedov HA. Arterial Restenosis: Past, Current Status and Future Directions. Journal of Chronic Disease Prevention and Care. 2024;1(1).
DOI : https://doi:10.33425/3065-7059-1004.
20. Jakubiak GK, Pawlas N, Cieślar G, Stanek A. Pathogenesis and clinical significance of in-stent restenosis in patients with diabetes. International Journal of Environmental Research and Public Health. 2021.
DOI : https://doi:10.3390/ijerph182211970.
21. Shah PK. Inflammation, neointimal hyperplasia, and restenosis: As the leukocytes roll, the arteries thicken. Circulation. 2003.
DOI : https://doi:10.1161/01.CIR.0000069943.41206.BD.
22. Sobolevskaya E V., Shumkov OA, Smagin MA, Guskov AE, Malysheva A V., Atuchin V V., et al. Markers of Restenosis after Percutaneous Transluminal Balloon Angioplasty in Patients with Critical Limb Ischemia. International Journal of Molecular Sciences. 2023.
DOI : https://doi:10.3390/ijms24109096.
23. Dinc R. A review of the current state in neointimal hyperplasia development following endovascular intervention and minor emphasis on new horizons in immunotherapy. Translational and Clinical Pharmacology. 2023.
DOI : https://doi:10.12793/tcp.2023.31.e18.
24. Mandaglio-Collados D, Marín F, Rivera-Caravaca JM. Peripheral artery disease: Update on etiology, pathophysiology, diagnosis and treatment. Medicina Clinica. 2023.
DOI : https://doi:10.1016/j.medcli.2023.06.005.
25. Golledge J. Update on the pathophysiology and medical treatment of peripheral artery disease. Nature Reviews Cardiology. 2022.
DOI : https://doi:10.1038/s41569-021-00663-9.
26. Kavurma MM, Bursill C, Stanley CP, Passam F, Cartland SP, Patel S, et al. Endothelial cell dysfunction: Implications for the pathogenesis of peripheral artery disease. Frontiers in Cardiovascular Medicine. 2022.
DOI : https://doi:10.3389/fcvm.2022.1054576.
27. Pelliccia F, Zimarino M, Niccoli G, Morrone D, De Luca G, Miraldi F, et al. In-stent restenosis after percutaneous coronary intervention: emerging knowledge on biological pathways. European Heart Journal Open. 2023.
DOI : https://doi:10.1093/ehjopen/oead083.
28. Iida O, Takahara M, Soga Y, Fujihara M, Kawasaki D, Hirano K, et al. A Novel Angiographic Risk Score for Femoropopliteal Interventions. Journal of Endovascular Therapy. 2020;27(6).
DOI : https://doi:10.1177/1526602820948472.
29. Yamauchi Y, Takahara M, Iwata Y, Suzuki K, Fujimura N, Yamaoka T, et al. Lesion Characteristics Associated with Loss of Primary Patency After Endovascular Therapy for Common Femoral Artery Lesions. Cardiovasc Intervent Radiol. 2023;46(3).
DOI : https://doi:10.1007/s00270-022-03343-4.
30. Conte MS, Bradbury AW, Kolh P, et al. Global vascular guidelines on the management of chronic limb-threatening ischemia. Eur J Vasc Endovasc Surg. 2019;58(1 Suppl):S1-S109.e33.
DOI : https://doi:10.1016/j.ejvs.2019.05.006.
31. Rinaldi A, Tepe G, Fanelli F, et al. Drug-eluting resorbable scaffold vs angioplasty for below-the-knee arterial disease (LIFE-BTK): a randomized controlled trial. N Engl J Med. 2024;390(1):9-19.
DOI : https://doi:10.1056/NEJMoa2305637.
32. Snyder DJ, Zilinyi RS, Pruthi S, George S, Tirziu D, Lansky A, Mintz AJ, Sethi SS, Parikh SA. Percutaneous transluminal angioplasty for infrapopliteal chronic limb-threatening ischemia: a systematic review and meta-analysis of primary patency and binary restenosis rates. J Endovasc Ther. 2025;32(5):1547-1561.
DOI : https://doi.org/10.1177/15266028231212133
33. Liang PL, Marcaccio CL, Darling JD, et al. Validation of the Global Limb Anatomic Staging System in first-time lower extremity revascularization. J Vasc Surg. 2021;73(6):1683-1691.
DOI : https://doi:10.1016/j.jvs.2020.08.151.
34. Hicks CW, Zhang GQ, Canner JK, Weaver ML, Lum YW, Black JH, et al. The global anatomic staging system does not predict limb based patency of tibial endovascular interventions. Ann Vasc Surg. 2021;75:79-85.
DOI : https://doi.org/10.1016/j.avsg.2021.04.007
35. Kodama A, Meecham L, Popplewell M, Bate G, Conte MS, Bradbury AW. Editor’s choice—relationship between global limb anatomic staging system (GLASS) and clinical outcomes following revascularisation for chronic limb threatening ischaemia in the bypass versus angioplasty in severe ischaemia of the leg (BASIL)-1 trial. Eur J Vasc Endovasc Surg. 2020;60(5):687-695.
36. Bontinis V, Bontinis A, Koutsoumpelis A, Giannopoulos A, Ktenidis K. A systematic review and meta-analysis of GLASS staging system in the endovascular treatment of chronic limb-threatening ischemia. J Vasc Surg. 2023;77(3):957-963.e3.
DOI : https://doi.org/10.1016/j.jvs.2022.07.183
37. Ichihashi S, Shibata T, Fujimura N, et al. Vessel calcification as a risk factor for in-stent restenosis in complex femoropopliteal lesions after Zilver PTX paclitaxel-coated stent placement. J Endovasc Ther. 2019;26(5):613-620.
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Copyright (c) 2026 April Hidayat, R Suhartonop, Marsma (Purn) Dr. dr. Wawan Mulyawan, SpBS, Subspes. N-TB, Sp.KP, AAK
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