Long-Term Outcomes of Jetstream Atherectomy Combined With Ranger Drug-Coated Balloon in Calcified Femoropopliteal
Jérôme Brunet1, Yann Gouëffic2, Jean-Pascal Peyre1
1Cardiovascular Department, Rhône Durance Clinic, Avignon, France.
Insights
Jetstream atherectomy followed by Ranger drug-coated balloon angioplasty demonstrated sustained 3-year patency and clinical benefit for challenging calcified femoropopliteal lesions. This combination therapy offers a promising solution for improving long-term outcomes in peripheral endovascular interventions.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Interventions
Background:
- Severely calcified femoropopliteal lesions pose significant challenges in peripheral endovascular interventions.
- Limited evidence exists on the long-term efficacy of atherectomy combined with drug-coated balloon angioplasty for these complex lesions.
Purpose of the Study:
- To evaluate the 3-year clinical outcomes of combining Jetstream atherectomy with Ranger drug-coated balloon (DCB) angioplasty.
- Assessing the efficacy in treating patients with calcified femoropopliteal arterial disease.
Main Methods:
- Retrospective single-center study of 50 patients (63 lesions) with femoropopliteal lesions, 56% severely calcified, 54% TASC C-D.
- Jetstream atherectomy was performed prior to Ranger DCB angioplasty.
- Primary endpoint: 36-month primary patency (freedom from restenosis or target lesion revascularization [TLR]).
Main Results:
- 36-month primary patency was 69.2%; freedom from TLR was 92.0%.
- 82.0% freedom from target vessel revascularization (TVR) at 36 months.
- Sustained Rutherford category improvement in 84.0% and ankle-brachial index (ABI) ≥0.9 in 68.6% at 36 months.
Conclusions:
- The combination of Jetstream atherectomy and Ranger DCB angioplasty provides durable long-term patency and clinical benefits.
- This approach is effective for managing complex calcified femoropopliteal lesions, with low reintervention rates.
- Further prospective studies are warranted to confirm these findings.
Background:
Calcified femoropopliteal lesions remain a major challenge in peripheral endovascular interventions. Vessel preparation with atherectomy before drug-coated balloon (DCB) angioplasty has been proposed to improve long-term outcomes, but evidence remains limited.
Aims:
To evaluate the 3-year clinical outcomes of Jetstream atherectomy combined with Ranger DCB angioplasty in patients with calcified femoropoplite.
Methods:
This retrospective, single-center study included 50 patients (74% male, mean age 72.7 ± 9.8 years) treated between 2016 and 2020 for 63 femoropopliteal lesions. Lesions were classified as severely calcified in 56% of cases and TASC C-D in 54%. Jetstream atherectomy was performed before Ranger DCB angioplasty. The primary endpoint was primary patency at 36 months, defined as freedom from restenosis or target lesion revascularization (TLR). Secondary endpoints included freedom from TLR and target vessel revascularization (TVR), Rutherford category and ankle-brachial index (ABI) improvement, limb salvage, and all-cause mortality.
Results:
TThe mean lesion length was 122.8 ± 78.9 mm. Bailout stenting was required in 6.3% of cases. Primary patency was 91.7% at 12 months and 69.2% at 36 months. Freedom from TLR was 98.4% at 12 months and 92.0% at 36 months. TVR freedom at 36 months was 82.0%. Rutherford improvement was observed in 92.0% of patients at 1 month and sustained in 84.0% at 36 months. ABI ≥ 0.9 was achieved in 69.4% at 1 month and 68.6% at 36 months. No major amputations or cardiovascular deaths occurred during follow-up.
Conclusion:
Jetstream atherectomy combined with Ranger DCB angioplasty provided sustained long-term patency, low reintervention rates, and durable clinical benefit in patients with calcified femoropopliteal lesions. Further prospective trials are needed to validate these findings.
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