Peripheral Artery Disease Management Open access Peer reviewed

Twelve-month outcomes of drug-coated balloon treatment for infrapopliteal chronic limb-threatening ischemia in the PRIME-WIFI study subgroup analysis

Yiming Ren, Julong Guo, Fan Zhang, Wei Zhang and 14 more

European journal of medical research | Jun 17, 2026

Abstract

Abstract

This study aims to evaluate the 12-month clinical outcomes of drug-coated balloon (DCB) treatment for infrapopliteal chronic limb-threatening ischemia (CLTI) in a real-world setting, and to provide evidence to inform clinical decision-making. Based on the PRIME-WIFI multicenter prospective registry, 538 patients (553 limbs) from 10 centers were consecutively enrolled between December 2020 and June 2023. All patients underwent infrapopliteal DCB angioplasty and were included in the 12-month outcome analysis. The primary endpoint was the freedom from major adverse events (MAE), including major amputation, all-cause mortality, and clinically driven target limb reintervention (CD-TLR). Secondary endpoints included amputation-free survival (AFS), sustained clinical improvement, and quality of life. The Kaplan–Meier method was used to estimate event rates, and Cox regression was applied to identify independent predictors of 12-month MAE. The 12-month MAE-free rate was 75.5%, AFS was 82.2%, major amputation-free rate was 95.9%, all-cause mortality-free rate was 85.7%, and CD-TLR-free rate was 91.4%. 58.4% of limbs showed sustained clinical improvement, with significant wound and infection improvement ( p < 0.001). Multivariate Cox regression revealed that BMI (HR 0.91, p = 0.004) and WIfI stage (HR 1.245, p = 0.042) were independent predictors of MAE. In this single-arm, real-world observational cohort, infrapopliteal DCB treatment was associated with acceptable 12-month clinical outcomes. Trial Registration ClinicalTrials.gov, NCT04710420, registered on January 8, 2021

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Authors

Researchers on this paper

Yiming Ren

first | Capital Medical University

Julong Guo

middle | Capital Medical University | ORCID 0000-0001-7544-7999

Fan Zhang

middle | Capital Medical University

Wei Zhang

middle | Shanghai Public Health Clinical Center | ORCID 0000-0001-7800-3189

Ziheng Wu

middle | First Affiliated Hospital Zhejiang University | ORCID 0009-0001-0898-8493

Zibo Feng

middle | Huazhong University of Science and Technology | ORCID 0009-0006-2940-8095

Xin Fang

middle | Hangzhou First People's Hospital

Qiang Li

middle | Qingdao University

Hongfei Sang

middle | Soochow University

Zhenyu Shi

middle | Fudan University

Weihao Shi

middle | Fudan University

Chunshui He

middle | Chengdu University of Traditional Chinese Medicine

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Citation

BibTeX

@article{Ren2026Twelve,
  title = {Twelve-month outcomes of drug-coated balloon treatment for infrapopliteal chronic limb-threatening ischemia in the PRIME-WIFI study subgroup analysis},
  author = {Yiming Ren and Julong Guo and Fan Zhang and Wei Zhang and Ziheng Wu and Zibo Feng and Xin Fang and Qiang Li and Hongfei Sang and Zhenyu Shi and Weihao Shi and Chunshui He and Xixiang Gao and Jianming Guo and Tong Zhu and Hui Zhuang and Ye Meng and Lianrui Guo},
  journal = {European journal of medical research},
  year = {2026},
  doi = {10.1186/s40001-026-04710-4},
  url = {https://doi.org/10.1186/s40001-026-04710-4}
}

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