CLINICAL SKILLS » ATHERECTOMY

Rotational Atherectomy in Calcified Long Lesions Demonstrated High Freedom from TLR Rate

The Importance of Real-World Data

Interventionalists have long said that many studies don’t include the types of patient and lesion characteristics that they see in real-world contemporary practice. A recent atherectomy registry observed long, 16.4 cm femoropopliteal lesions, nearly 48% of which included grade 3 or 4 calcium.

“It's a real-world registry… we didn't exclude a lot of things…” – Dr. Nicolas Shammas

Hear more about atherectomy data from Dr. Shammas

The JET Registry1

The JET Registry observed the treatment effects of the Jetstream™ Atherectomy System in peripheral arterial disease of the common femoral, superficial femoral, or popliteal arteries. At 12-months results showed 77.2% patency and 81.7% freedom from TLR. Results also demonstrated a strong safety profile with a 1.4% distal embolization rate.

Patient and Lesion Characteristics

JET Registry patients had real-world, long, femoropopliteal lesions and slightly over one-third were occluded. Calcium was visible in 90% of the lesions and grade 3 and 4 calcium was present in 47.7% of lesions.

   

Lesion Calcium Grades

19.5% 4 is dense circumferential calcification along the segment length
28.2% 3 is aggregate calcification representing >50% of the segment length
24.1% 2 is aggregate calcification representing <50% of the segment length
16.2% 1 is one individual segment of vessel calcification representing <25% of the length of the entire segment
10.0% 0 is no visible calcification
 

EFFICACY AND OUTCOMES

At 12 months, results showed:

* Patency based on a DUS PSVR ≤2.5; Binary Restenosis was reported as 22.8%.  The JET Registry had limited DUS follow-up at 12 months (57/241 patients)
 

Patient Safety

JET Registry results demonstrated a strong safety profile.


Procedure Details

Catheter Sizes

• 47.2% used 2.1/3.0 mm

• 49.4% used 2.4/3.4 mm

Number of Passes (average*)

• 2.0 blades down

• 1.8 blades up

Embolic Protection

• 22.4% of cases


Jetstream Runtime (average*)

• 4.7 minutes

* Jetstream Runtime: 4.7 minutes ± 3.5 minutes; Number of Passes: 2.0 blades down ± 1.5 passes and 1.8 blades up ± 1.4 passes. There were no clear stenting parameters set, stent placement was performed at operator’s discretion, and 84 patients (35%) received adjunctive stents.
 

SUBGROUP RESULTS

At 12 months, results showed:

Number of Patients: Non-Stent (157), Stent (84), Diabetic (99). Patency based on a DUS PSVR ≤2.5; Binary Restenosis Reported: Non-Stent: 20.5%; Stent: 27.8%; Diabetic Patients: 33.3%. The study was not powered to show differences between groups.

 

SUMMARY

JET Registry data demonstrated:

  • The JET Registry saw a 77.2% patency†† rate in patients with real-world, long femoropopliteal lesions (16.4 cm). No DCBs were used in this study 
  • There was a high freedom from TLR rate of 81.7% at 12 months
  • There was a low distal embolization rate, 1.4% or 3 events
  • Calcium was present in most of the lesions and grade 3 and 4 calcium was present in 47.7% of lesions
  • The Jetstream Atherectomy System had a high procedural success rate, 98.3% of patients had ≤30% residual diameter stenosis post-procedure

†† Patency based on a DUS PSVR ≤2.5; Binary Restenosis was reported as 22.8%.

1. Garcia, L. (2017). Jetstream atherectomy in treating de novo or non-stent restenotic femoropopliteal disease: One-year results from the JET registry. Registry results presented at the Leipzig Interventional Course (LINC), Leipzig, Germany

View the JET Registry manuscript published in Cardiovascular Revascularization Medicine


In a recent single center experience, Jetstream with DCB had a superior freedom from TLR rate at 18-months compared to
Jetstream with PTA, reflecting real-world practice
View JET-SCE Data


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