Adjunctive Scoring Balloon With Jetstream Atherectomy Improves 1-Year Patency Compared With Jetstream Alone in Femoropopliteal Disease: Results of the JETCUT Study

PURPOSE: Drug-coated balloons (DCBs) are widely used for femoropopliteal (FP) disease; however, severe calcification can hinder drug uptake and increase the risk of restenosis. Atherectomy and scoring balloons are commonly employed for vessel preparation, but whether combining a scoring balloon with Jetstream atherectomy enhances outcomes remains unclear. The current study aimed to compare the immediate procedural success and 1-year outcomes of Jetstream atherectomy combined with adjunctive scoring-balloon angioplasty versus Jetstream atherectomy alone for the treatment of severely calcified FP lesions. MATERIALS AND METHODS: We retrospectively evaluated 283 consecutive limbs with severely calcified FP lesions treated with Jetstream atherectomy, either with (n = 128) or without (n = 155) adjunctive scoring-balloon angioplasty, across 8 cardiovascular centres in Japan between October 2022 and December 2024. After propensity-score matching, 160 limbs with balanced clinical, lesion and procedural characteristics were analysed. Immediate procedural success was defined as residual stenosis <30% without angiographic dissection worse than type B. No baseline characteristic demonstrated a significant interaction between treatment strategy and the risk of 1-year restenosis. CONCLUSION: Combining adjunctive scoring-balloon angioplasty with Jetstream atherectomy improved both immediate procedural success and 1-year vessel patency in the treatment of severely calcified FP lesions, supporting combined plaque modification as an effective vessel-preparation strategy before DCB therapy.Clinical ImpactDurable patency in severely calcified femoropopliteal lesions remains a major challenge in drug-coated balloon-based endovascular therapy. Although atherectomy and scoring balloons are both used for vessel preparation, their combined clinical benefit has not been well established. The authors of this study compare Jetstream atherectomy with and without adjunctive scoring-balloon angioplasty in real-world practice. The findings demonstrate that combined plaque debulking and controlled vessel modification improve immediate procedural success and 1-year primary patency. These results support a combined vessel-preparation strategy as a practical approach to enhance the effectiveness of DCB therapy in heavily calcified femoropopliteal disease.