Factors Associated With Vessel Injury Caused by Atherectomy in the Treatment of Severely Calcified Femoropopliteal Lesion

ABSTRACT Background The factors predicting vessel injury during the use of the Jetstream atherectomy system (JS) for femoropopliteal (FP) lesions have not been fully investigated. Aim This study aimed to identify factors associated with vessel injury when using the JS in severely calcified FP lesions. Methods This was a single‐center, retrospective observational study. A total of 57 patients with 68 FP lesions underwent endovascular therapy (EVT) using the JS between April 2024 and May 2025. Vessel injury was defined as evidence of medial or adventitial disruption on intravascular ultrasound evaluation. The primary outcome was the presence of vessel injury, and associated factors were analyzed. A secondary outcome was the impact of vessel injury on adverse events (AE). Results The JS was used in 44% of popliteal artery lesions and 63% of nodular calcification lesions. Vessel injury was observed in 46% of cases. Factors associated with vessel injury included atherectomy in the popliteal lesion (odds ratio [OR]: 3.608; 95% confidence interval [CI]: 1.173–11.098; p = 0.025) and the presence of nodular calcification (OR: 7.232; 95% CI: 2.105–24.846; p = 0.002). Predictors significantly associated with AE included chronic total occlusion (Hazard ratio [HR]: 3.867; 95% CI: 1.049–14.284; p = 0.042), vessel injury (HR: 4.912; 95% CI: 1.342–17.981; p = 0.015), and minimum lumen area after EVT (HR: 0.884; 95% CI: 0.798–0.979; p = 0.018). Conclusion The current study revealed that the utilization of the JS is associated with an elevated risk of vessel injury, particularly in cases involving lesions of the popliteal artery and those characterized by nodular calcification.