Reverse flow-controlled atherectomy treatment using the JETSTREAM atherectomy device for reducing distal embolization

Severely calcified femoropopliteal lesions remain technically challenging, with distal embolization (DE) being a major concern during atherectomy. We developed a new method, the reverse flow-controlled atherectomy treatment (R-CAT), using the JETSTREAM system, to enhance embolic protection. By combining retrograde insertion of an occlusion catheter with distal flow arrest and aspiration, R-CAT enables safe atherectomy even in long, heavily calcified lesions with poor tibial runoff. In a representative case, both technical and procedural success were achieved without complications or DE. R-CAT is a feasible and safe approach for reducing DE and enhancing procedural safety in complex femoropopliteal disease.