PERFECT-2: Angioplasty Can Effectively Treat Erectile Dysfunction But Restenosis an Issue

PARIS, France—Balloon angioplasty offers durable symptom relief in patients with erectile dysfunction and isolated penile artery stenosis for up to 1 year after treatment, according to late-breaking findings from the PERFECT-2 study presented May 20, 2015, at EuroPCR. However, restenosis developed 6 in 10 patients.

Take Home:  PERFECT-2: Angioplasty Can Effectively Treat Erectile Dysfunction But Restenosis an Issue

For the single-center study, a team led by Tzung-Dau Wang, MD, of National Taiwan University Hospital (Taipei, Taiwan), looked at 28 patients—all of whom had erectile dysfunction (score of 5-21 on the International Index of Erectile Function [IEFF]-5 questionnaire) and isolated penile artery lesions on CT angiography (CTA)—who underwent balloon angioplasty between December 2012 and January 2014. Full follow-up data were available for 22 patients (n = 34 lesions).

At baseline, mean age was 61 years. Mean IIEF-5 score was 10.1, with half of patients having either moderate (score 8-11; 9%) or severe (score 5-7; 41%) symptoms. Two-thirds (68%) had comorbid CAD. Four patients had bilateral disease, and 73% of lesions were located in the common penile artery. On CTA, the reference vessel diameter was 1.7 ± 0.4 mm. No lesions had calcification.

Promising, But Not PERFECT

Mean lesion stenosis increased from 76.9% at baseline to 9.5% post-angioplasty. Technical success (defined as diameter stenosis ≤ 30% with adequate distal runoff) was achieved in 97% of cases. Flow-limiting dissection occurred in 2 patients (6%). There were no access-site complications or cases of perineal hematoma.

At 6 to 9 months after treatment, values for minimal diameter, percent diameter stenosis, and lesion length all continued to be more favorable than at baseline (table 1).

Table 1. Per-Lesion CTA Findings in Patients With Erectile Dysfunction, Penile Artery Lesions

Overall, 14 lesions (41%) showed evidence of binary restenosis (≥ 50% diameter stenosis). But Dr. Wang noted that on a per-patient basis, the rate of restenosis “was quite high” at 59%. Lesions with restenosis tended to occur in patients who were older (mean age 63 vs 59.1 years; P = .049) and in vessels with smaller reference diameter (mean 1.57 vs 1.81 mm; P = .06).

Nonetheless, 55% of patients still met the definition for clinical success (change in IIEF-5 score ≥ 4 compared with baseline or a score of ≥ 22 at follow-up) at 12 months. Patients with improved symptoms were more likely to be younger (mean 57.3 vs 65.3 years; P = .027) and had a lower prevalence of binary restenosis (33% vs 90%; P = .007). Thus, restenosis “was closely related to treatment failure,” Dr. Wang pointed out.

An “Unmet Need”

“Our findings highlight an unmet need for a more enduring treatment modality for penile artery stenotic diseases,” he concluded.

Panel member Nick Ossei-Gerning MBBS, MD, University Hospital of Wales (Cardiff, Wales) noted that this is not the first time this intervention has been attempted. “As you know in the 1980s, a few people were doing balloon angioplasty for erectile dysfunction and it was abandoned, primarily because of restenosis,” he commented. “Why do you think you are achieving better results now with just ‘plain old balloon angioplasty’”?

Dr. Wang said that one reason balloon angioplasty is used in this setting is because the penile artery is too small—at generally less than 2.0 mm—for other types of intervention. “The only tool I have is balloon angioplasty, or maybe a drug-eluting balloon,” he explained, though he did not elaborate on whether improvements in technology or some other factor could explain why the treatment appears to work better today than 30 years ago.

In an email, Ajay J. Kirtane, MD, SM, of Columbia University Medical Center (New York, NY), told TCTMD that without more effective noninvasive screening to identify patients with penile artery lesions—and to pinpoint those whose lesions are causing their erectile dysfunction—this therapy is unlikely to become mainstream. Moreover, he added, “it seems to me that the rates of restenosis would be a further limiting factor here.”

Wang T-D. Computed tomographic angiography follow-up and 12-month clinical outcome following balloon angioplasty for isolated penile artery stenoses in patients with erectile dysfunction: the PERFECT-2 study. Presented at: EuroPCR; May 20, 2015; Paris, France.


  • Dr. Wang reports no relevant conflicts of interest.

Related Stories:

We Recommend



maggie steven

1 week ago
Hello everyone, am very happy to share this little awesome testimony about Dr Adam a great herbal doctor who help me enlarge my penis size from 4.2 cm to 9.4 cm longer with his herbal cream mixture, am so amazed with the autonomous size of my penis , if you are also in need of help on how to enlarge your penis size to become bigger and stronger I adverse you to contact Dr Adam today on his email ( you can contact him on Whatsapp number +2348151731392 because he is one of the best herbal doctor that i can only show you up to, if your penis is 4.2 cm and want to get it reach 9.4 cm within three weeks Dr Adam is also specialized on breast enlargement,Cronic heart disease,HIV cure and so many other things so i advise you to contact him for help. +2348151731392

Linfield Sarah

3 months ago
It is such an amazing thing to experience freedom from ED after several years of battling Erectile Dysfunction, it took me more than a decade to finally see the right person that helped me from Erectile Dysfunction. Many years ago (in my late 30s) i was using some antidepressant drugs which later took bad effects on me and caused my Erectile Dysfunction (ED), in my late 40s my ED was getting worse that i was already having huge problems with my penis erections. This i believe was the main cause of my two divorce within a period of 5 years. i am now 53 years old and just some months ago, i read about an African herbal practitioner called Dr. Henry Bude, i checked about him and found out that he was famous for treating ED, other sicknesses and Penis Enlargements. I contacted him and explained my problem to him, as soon as he got my message he replied back to me and just within few days i ordered a herbal medicine from him. I was placed on the medication by the Dr and after about 2 weeks of taking the medicine i started noticing that i could hold erection more better than before. I continued for more weeks till i could finally hold my erection normally again and right now i can last more and more in sex. My penis erection now is hard and firm enough to satisfy any woman. i feel very young below now, and i can notice that my new marriage is better now since Dr. Henry Bude helped me with the herbal medicine that cured my Erectile Dysfunction. If you also suffer from ED at your age, i want you to know that the age can't limit your happiness, take the chance and be freed from the fear not been a ma. contact Dr. Henry Bude now on: DR.HENRYBUDE@GMAIL.COM for help . my email too is
Load More