Safety of Rotational and Aspirational Atherectomy for Lower Extremity Interventions without Distal Filter Protection

Purpose: To evaluate the use of rotational and aspirational atherectomy system without the use of distal filter placement for lower extremity arterial revascularization at a single center

Materials and Methods: Retrospective chart review of patients who underwent lower extremity arteriograms from July 2017 to September 2018 was performed. Procedures in which the JetStream rotational and aspirational atherectomy system (Boston Scientific, Maple Grove, MN) was used were identified. Both the XC and SC devices were used. Patient medical records were reviewed for demographics, medical history, characteristics of lesions treated, and postprocedural adverse events. Angiograms were also reviewed retrospectively by two authors for concurrence.

Results: Twenty-nine procedures using Jetstream atherectomy device jet were performed in 23 patients (14 men, 9 women; average age, 69.1 years) over the 14-month period. Twelve de novo femoropopliteal and 4 tibioperoneal lesions were treated. There were 7 femoropopliteal in-stenosis that were treated with an average lesion length of 10.5 cm. The average lesion length was 6.1 cm for the 4 treated tibioperoneal lesions. Adjunct balloon angioplasty was performed in all procedures. If needed, stents were placed in the proximal, mid, or distal superficial femoral artery. Intravascular ultrasound examination was performed in 15 of 29 procedures with 53% lesions showing calcified plaque. Distal protection filters were not used in any patients. There were no device-related adverse events. There were no angiographically visible or clinically significant instances of distal embolization. No other device-related complications were noted. Four patient developed access site hematomas, which were self-limiting.

Conclusions: JetStream rotational atherectomy for lower extremity arterial interventions may be safely performed without the use of distal filter protection.