Long-Term Outcomes of Jetstream Atherectomy Combined With Ranger Drug-Coated Balloon in Calcified Femoropopliteal Lesions: A Three-Year Single-Center Experience.

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.