Impact of Intra-Calcium Wiring Followed by Rotational Atherectomy and Subsequent Drug-Coated Balloon Treatment for Femoropopliteal Artery Calcified Lesions.

BACKGROUND

Severely calcified femoropopliteal lesions remain challenging for endovascular therapy. The Aggressive Wire Recanalization in Calcified Atheroma and Dilatation (ARCADIA) technique enables intra-calcium wiring, potentially facilitating subsequent plaque modification. However, the clinical utility of combining ARCADIA with rotational atherectomy and drug-coated balloon (DCB) therapy requires further evaluation.

AIMS: To investigate the clinical outcomes of combining intra-calcium wiring (ARCADIA technique) with Jetstream atherectomy followed by DCB in treating severely calcified femoropopliteal artery lesions.

METHODS

This retrospective study included patients with symptomatic lower extremity artery disease (LEAD) and PACSS grade 3-4 femoropopliteal lesions treated between April 2020 and July 2024. Patients were divided into two groups: Jetstream (ARCADIA + Jetstream + DCB) and non-Jetstream (ARCADIA + DCB). Primary endpoints were 1-year primary patency and freedom from clinically driven target lesion revascularization (CD-TLR).

RESULTS

Among 67 patients with 100 lesions, 27 (38 lesions) received Jetstream-based therapy and 40 (62 lesions) underwent ARCADIA with DCB alone. One-year primary patency was significantly higher in the Jetstream group (92.4% vs. 75.9%, p = 0.024), as was freedom from CD-TLR (96.6% vs. 83.1%, p = 0.031). No major complications, including perforation, embolization, or acute limb ischemia, occurred in either group.

CONCLUSIONS

Combining ARCADIA with Jetstream atherectomy and DCB significantly improves patency and reduces CD-TLR in severely calcified femoropopliteal lesions. The ARCADIA technique plays a key role in safely enabling effective atherectomy in these complex cases.