This study evaluated the safety and efficacy of the Jetstream Pathway device for treating femoropopliteal arterial lesions. 86 patients underwent atherectomy with this device between 2008-2009. The target lesion revascularization rate was 15% within 6 months. Reintervention was most common in the first 3 months and for TASC II type B lesions, with balloon angioplasty used in nearly half of reintervention cases. The Jetstream Pathway showed advantages for femoropopliteal atherectomy with low stent use and reinterventions often managed through endovascular techniques. Long-term follow up is still needed to assess durability.

1. ______ _________ ____ ___ __
_____ ______ _____ ___
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Initial Experience with the
Jetstream™ Pathway Device
for Femoro-Popliteal Disease
Imran Javed, MBBS, FCPS.
Vekatesh Ramaiah, MD, FACS
David Terry, MD
Julio Rodriguez, MD, FACS
Matt Nammany, MD

2. ABSTRACT
Initial Experience with the Jetstream™ Pathway Device for Femoro-Popliteal
Disease.
Imran Javed, MBBS, FCPS., Vekatesh Ramaiah, MD, FACS., David Terry, MD.,
Julio Rodriguez, MD, FACS., Matt Nammany, MD.
Arizona Heart Institute, Phoenix, Arizona, USA.
Objectives: To report safety and efficacy of Jetstream™ Pathway rotational
atherectomy/ thrombectomy device for the treatment of femoro-popliteal arterial
lesions with special emphasis on rate of re-intervention and intervention free
period.
Materials & Methods: Duration of study is from Mar 2008 to Nov 2009 (21Months).
Total numbers of patients is 86. Males are 55(64%) & Females are 31(36%). Age
range is 36 to 87 Years. All patients underwent Pathway Atherectomy during this
time period regardless of their previous status were included. Re intervention in
the same limb after atherectomy was endpoint of the study.
Results: TLR (Target Lesion Revascularization) was 15% in patients during follow
up period. Re intervention was more common in first 3 months after first
intervention. It was more common in TASC II type B lesions and mostly
managed by Balloon Angioplasty. Conclusion: The JetStream™ Pathway
device with thrombectomy and aspiration capabilities has added advantages to
femoro-popliteal atherectomy. Adjunctive stenting remains very low in this
difficult segment.Long term follow up will definitely be needed for durability and
patency.
Key Words: Femoro-Popliteal Disease, JetStream™ Pathway device, Re
intervention.

3. Purpose of Study
• To report safety and efficacy of
Jetstream™ Pathway rotational
atherectomy/ thrombectomy device for
the treatment of femoro-popliteal
arterial lesions with special emphasis
on rate of re-intervention and
intervention free period.

4. PATIENTS & METHODS
• Duration: Mar 2008 to Nov 2009 (21M).
• Total patients: 86
• Sex: Males 55(64%) Females 31(36%).
• Age range: 36 to 87 Yrs.
• Inclusion Criterion:
– All patients underwent Pathway Atherectomy during this time
period regardless of their previous status.
• End point of study:
– Re intervention in the same limb after atherectomy and
determine intervention free time period.

5. PATHWAY DEVICE

6. CLINICAL FINDINGS
• Total No of Lesions: 113
• Site of Lesion:
– SFA: 74 (65.5%)
– Popliteal: 30 (26.6%)
– Other Vessels: 4 (3.5%)
– Instent Restenosis: 4 (3.5%)
– Femropopliteal Bypass: 1 (0.9%)

7. • Presentations:
Rutherford Class I: Claudication: 58 (67.4%)
Rutherford Class II: Rest Pain: 13 (15.1%)
Rutherford Class III: Tissue Loss: 15 (17.5%)
• Limb Involved:
• Right: 32 (37%)
• Left:54 (63%)
CLINICAL FINDINGS

8. CLASSIFICATION OF LESIONS ON BASIS
OF TASC II GUIDELINES
24 23
18
13
8
0
5
10
15
20
25
30
Type A Type B Type C Type D Undefined
27.9% 26.7% 20.9% 15.1% 9.4%

9. OPERATIVE FINDINGS
Type of Pathology:
Occlusion: 47 (54.7%)
Stenosis: 27 (31.4%)
Both: 12 (13.9%)
Distal Run Off:
Single Vessel: 43 (50%)
Double Vessel: 31 (36%)
Triple Vessel: 3 (3.5%)
Collaterals: 9 (10.5%)

10. FOLLOW UP OF PATIENTS
• 3-6 Month: 10 (11.6%)
• 6-12 Months: 71 (82.6%)
• > 12 Months: 5 (5.8%)

11. Pathway Jetstream™ Atherectomy
of Severe Calcific Popliteal Stenosis
Severe calcific 90%
stenosis of the popliteal
artery across the knee
joint
Excellent post Jetstream™ atherectomy results,
without dissection, PTA or embolization

12. REINTERVENTIONS
• Total: 13 (15.1%)
• Limb Involved:
• Right: 6 (46%)
• Left: 7 (54%).
• Time Line:
• 0-3 Months: 8 (61.5%)
• 4-6 Months: 1 (7.7%)
• >6 Months: 4 (30.8%)

13. Reintervention In Different Types
of Lesions (Tasc II)
Type A: 1 (4.2%)
Type B: 6 (26.1%)
Type C: 2 (11.1%)
Type D: 2 (15.4%)
Undefined: 2 (25%)
REINTERVENTIONS

14. TYPES OF RE-INTERVENTIONS
Balloon Angioplasty+- Stent: 6 (46.2%)
Remote Endarterectomy: 2 (15.3%)
Repeat Atherectomy: 4 (30.8%)
Below Knee Amputation: 1 (7.7%)

15. RESULTS
• TLR was 15% in patients at 6 months as
only 5.8% have completed 1 year
• Reintervention was more common in first 3
months after first intervention (learning
curve)
• Reinterventions were mostly balloon
angioplasty in nearly half of cases.
• Reinterventions were more common in
TASC II type B lesions.

16. Conclusion
• The JetStream™ Pathway device with
thrombectomy and aspiration capabilities has
added advantages to femoro-popliteal
atherectomy
• Reninterventions were managed mostly by
endovascular techniques.
• Intervention free period is similar to reports from
other institutions especially from Germany.
• Long term follow up and comaprison with other
athrectomy devices will definitely be needed for
durability and patency