234 - A Novel Therapeutic Combination for Complex Femoropopliteal Lesions: Rotational Atherectomy via Retrograde Popliteal Access Without Embolic Protection

Purpose: Rotational atherectomy with aspiration, followed by drug-coated balloon (DCB) angioplasty, is an emerging method for the endovascular treatment of femoropopliteal artery disease without the use of stents. Due to the risk of distal embolism, this technique is typically performed with an embolic protection device. Retrograde popliteal artery (RPA) access offers a valuable alternative access for treating femoropopliteal artery disease. The combination of these two methods may lead to a new approach that eliminates the need for embolic protection. This study aims to evaluate the efficacy and safety of RPA in treating complex femoropopliteal lesions using a rotational atherectomy device and DCB, specifically without embolic protection.

Materials and Methods: This single-center, retrospective study included patients with both new and calcified TASC B and C lesions located in the common and superficial femoral arteries, as well as the above-knee popliteal arteries (P1 segment), between January 2021 and August 2025. Patients with P2 and more distal popliteal artery involvement, in-stent restenosis, or recent occlusions (less than 1 month) were excluded from the study. All participants had severe claudication (Rutherford class 3). All patients underwent rotational atherectomy with aspiration (JetStream, Boston Scientific, MA, USA) using a retrograde approach through the popliteal artery, followed by post-dilatation with an appropriately sized DCB (Ranger, Boston Scientific, MA, USA). No embolic protection device was utilized. The evaluation focused on technical success, embolic events, patency rates, and complications.

Results: Twenty-two patients participated in the study, including 18 males (81.8%), with an average age of 69.9 ± 7.9 years. Only one patient required stenting of the target lesion, resulting in a technical success rate of 95.5%. There were no observed embolic events during or after the procedure, and no procedure-related mortality, amputations, or major complications occurred. A minor complication, specifically a hematoma at the popliteal artery puncture site, was noted in one patient (4.5%). One-year follow-up data were available for 19 patients, showing a primary patency rate of 89.5% and a secondary patency rate of 94.7%.

Conclusion: The treatment of complex femoropopliteal lesions using rotational atherectomy with aspiration and DCB via RCP without embolic protection has been shown to be safe and effective. Further large-scale studies will contribute to establishing this alternative method.