A Novel Guidewire Bias Modification Method for Atherectomy of Severely Calcified Femoropopliteal Lesion

BACKGROUND: The Jetstream atherectomy catheter is an effective option for treating severely calcified femoropopliteal lesions. However, unfavorable guidewire bias may result in inadequate plaque debulking. CASE SUMMARY: A 55-year-old man with a severely calcified popliteal artery lesion underwent endovascular treatment. Initial atherectomy failed to achieve sufficient luminal gain because of unfavorable guidewire bias. During the second procedure, intentional modification of the guidewire bias using our novel technique, JETstream using the Bidirectional and Intentional Atherectomy System (JET BIAS), enabled effective plaque debulking. DISCUSSION: In tortuous vessels, Jetstream catheter tends to track along the outer curvature, leading to insufficient debulking. JET BIAS redirects the catheter toward the calcified plaque by applying tension to an externalized guidewire. Preprocedural evaluation of intravascular imaging is crucial to predict whether JET BIAS is effective. TAKE-HOME MESSAGE: The JET BIAS method may be useful for achieving effective atherectomy in severely calcified femoropopliteal lesions with unfavorable guidewire bias.