The Jetstream® device is one of the most versatile atherectomy systems available, Brantley says. It treats diseased arteries both above and below the knee and performs both atherectomy and thrombectomy from the same catheter. A rotational cutting design supports concentric lumens which facilitate laminar flow, and the Jetstream® is the only atherectomy device with continuous active aspiration.
“There are other devices with different profiles and address different types of lesions, but most of them concentrate on heavy calcification. I use the Jetstream because it is probably the most versatile device out there,” Brantley says. “It tackles all lesion morphologies and is the only one indicated for atherectomy and thrombectomy. Also, its built-in aspiration feature decreases the risk of distal embolization.”
Brantley says he has achieved phenomenal results with the device as a stand-alone therapy. “I’ve done procedures on patients with significant disease in their superficial femoral artery and have been able to perform the atherectomy by itself,” he says. “The trend now is to follow that procedure with a drug-coated balloon to avoid stent placement. This device is set apart from the rest with its built-in aspiration catheter and its ability to focus on all lesions, including thrombus, calcium, soft plaque, fibrous plaque and total occlusions.”
The first step in treating PAD patients is medical therapy, exercise therapy and risk factor modification. But for people who continue to have symptoms despite those therapies, the device is useful for addressing the arterial lesions. “The treatment isn’t for every patient, but it has been my go-to way of treating patients with predominately lifestyle limiting claudication or critical limb ischemia,” Brantley says. “Without the device, one option would be angioplasty on a vessel that is heavily calcified. That calcification can prevent you from getting the artery lumen open enough to expand. Six months later, if that artery had a stent placed and closes, your only option may be bypass surgery.”
The identification of PAD patients usually happens in primary care physician offices and Brantley encourages that those patients be referred to a specialist for further evaluation. “Anyone who comes into a physician’s office with leg pain that is concerning for claudication should be screened with a simple ankle brachial index (ABI), a cost effective test. If the ABI is abnormal, the patient should be referred because these patients are at high risk for experiencing a cardiovascular event such as stroke or heart attack. We need to treat these patients aggressively for secondary prevention with medical therapy and treat them as if they have coronary artery disease, because most of them do.”
In today’s health care environment, technology often surpasses the updating of guidelines for a variety of illnesses and conditions. Brantley says that is another reason to refer patients to the appropriate specialist. “Refer to a physician who is up-to-date on current therapies. PAD patients with stable claudication usually can be treated successfully with a combination of exercise, daily walking and pharmacological therapy,” he says. “However, a fair amount of those patients will have worsening claudication and those are the people who should be looked at for the therapy offered by the atherectomy devices.”
Brantley believes that PAD is under-diagnosed and under-treated, compared to coronary artery disease. “Most of the people with stable claudication are not going to progress to critical limb ischemia or amputation. You can treat those patients medically. However, there are a lot of people who have limiting claudication and they just deal with the problem, but they don’t have to,” he says. “We now have effective therapies available to treat these patients in minimally invasive ways. Many can have a procedure and go home the next morning. In these patients I see, even more so than in cardiac patients, the dramatic change they have in their lifestyle after being treated effectively.”
Photos of occluded artery before and after atherectomy with Jetstream®.
Jetstream device in action. Aspiration port is directly behind the blades.
Brantley achieves good results with revascularization device.