Filter-Free Retrograde Popliteal JETSTREAM Atherectomy Followed by Drug-Coated Balloon Angioplasty: Procedural Safety and One-Year Clinical and Hemodynamic Outcomes

BACKGROUND: Endovascular revascularization is an established treatment for symptomatic femoropopliteal peripheral artery disease. Drug-coated balloon angioplasty allows antiproliferative drug delivery without permanent metallic implantation, while atherectomy may facilitate lesion preparation in calcified and occlusive disease. This study evaluated the procedural safety and one-year clinical and hemodynamic outcomes of filter-free retrograde popliteal JETSTREAM atherectomy followed by drug-coated balloon angioplasty, with additional assessment of dual antiplatelet therapy adherence and continued smoking. METHODS: This retrospective, single-center observational study included 107 patients with Rutherford category 4–5 femoropopliteal peripheral artery disease who underwent JETSTREAM atherectomy exclusively through retrograde popliteal access followed by Ranger paclitaxel-coated balloon angioplasty. No distal embolic protection device was used. Aspirin 100 mg and clopidogrel 75 mg daily were prescribed for 12 months. The primary procedural safety endpoint was clinically evident distal embolization within 24 hours. Longitudinal outcomes included tibialis posterior artery and dorsalis pedis artery Doppler waveform scores, Rutherford category, and ankle-brachial index. Outcomes were compared according to dual antiplatelet therapy adherence and smoking status. Exploratory multivariable logistic regression was performed for factors associated with treatment non-adherence. RESULTS: Mean age was 67.0±6.9 years, and 69.2% of patients were male. Total occlusions were present in 45.8%, PACSS grade 4 calcification in 83.2%, and adjunctive stenting was required in 21.5%. No clinically evident distal embolization occurred within 24 hours (0/107; upper two-sided 95% exact confidence limit, approximately 3.4%). At one year, mean tibialis posterior artery and dorsalis pedis artery waveform scores improved from 1.05±0.42 to 2.42±0.71 and from 1.07±0.60 to 2.28±0.74, respectively; mean Rutherford category decreased from 4.16±0.37 to 1.64±1.17, and median ankle-brachial index increased from 0.59 to 1.20 (all P< .001). Seventy-seven patients (72.0%) were adherent to dual antiplatelet therapy. At one year, adherent patients had better tibialis posterior artery (2.69 vs 1.73), dorsalis pedis artery (2.56 vs 1.57), Rutherford category (1.13 vs 2.93), and ankle-brachial index (1.218 vs 0.873; all P< .001). Forty-six patients continued smoking. Compared with patients not smoking during follow-up, continued smokers had poorer one-year tibialis posterior artery (2.24 vs 2.56; P=.036), dorsalis pedis artery (2.04 vs 2.46; P=.004), Rutherford category (2.02 vs 1.34; P=.002), and ankle-brachial index (1.044 vs 1.179; P=.004). Continued smoking was independently associated with dual antiplatelet therapy non-adherence (adjusted odds ratio, 3.43; 95% confidence interval, 1.27–9.29; P=.015). CONCLUSIONS: Filter-free retrograde popliteal JETSTREAM atherectomy followed by drug-coated balloon angioplasty was associated with substantial one-year clinical and hemodynamic improvement and no clinically evident distal embolization in this cohort. Dual antiplatelet therapy adherence was associated with better one-year outcomes, whereas continued smoking was associated with poorer outcomes and greater non-adherence.