Trial of Pantheris System, an Atherectomy Device That Provides Imaging While Removing Plaque in Lower Extremity Arteries (COMBINE-II)

Inclusion Criteria:

1. Age ≥ 18 years old.
2. Patient is a candidate for percutaneous intervention for peripheral vascular disease in the legs.
3. Patient is willing and able to give informed consent
4. Documented symptomatic atherosclerotic peripheral vascular disease Rutherford Classification 2-5.
5. Reference vessel lumen proximal to target lesion >3.0 mm in diameter by visual estimation.
6. Subject has de novo target lesion(s) with stenosis >70% by visual estimation distal to the profunda femoral artery. No more than 2 lesions may be treated with the Pantheris device.
7. Target lesion length <10 cm if target lesion >70% and <99% stenosed. If target lesion a chronic total occlusion (99-100% stenosed), target lesion length <4 cm.
8. Patient is capable of meeting requirements and be present at the follow-up clinic visits at 30 days.
9. At least one patent tibial run-off vessel at baseline. -

Exclusion Criteria:

1. Subject is pregnant or breast feeding.
2. Rutherford Class 0 to 1 (asymptomatic and mild claudication).
3. Rutherford Class 6 (critical limb ischemia).
4. Severe calcification of the target lesion.
5. Target lesion with any type of stent or graft.
6. Target lesion in the iliac artery.
7. Target lesion stenosis <70%.
8. Subjects with significant (>70%) occlusive lesions proximal to the target lesion not successfully treated during the index procedure (upstream disease) and prior to treatment of the target lesion.
9. Endovascular or surgical procedure performed on the index limb less than or equal to 30 days prior to the index procedure.
10. Planned endovascular or surgical procedure 30 days after the index procedure.
11. Lesion in the contralateral limb requiring intervention during the index procedure or within 30 days of the index procedure.
12. Subjects with active infections whether they are being currently treated or not.
13. Hemodialysis or GFR <30 mL/min or creatinine level >2.5mg/dL.
14. Evidence or history of intracranial or gastrointestinal bleeding, intracranial aneurysm, myocardial infarction or stroke within the past 2 months.
15. Evidence or history of aneurysmal target vessel within the past 2 months.
16. History of severe trauma, fracture, major surgery or biopsy of a parenchymal organ within the past 14 days.
17. Known allergy to contrast agents or medications used to perform endovascular intervention that cannot be adequately pre-treated.
18. Subjects in whom anti-platelet, anticoagulant, or thrombolytic therapy is contraindicated.
19. History of heparin-induced thrombocytopenia (HIT).
20. Uncorrectable bleeding diathesis, platelet dysfunction, thrombocytopenia with platelet count less than 125,000/mm2 , known coagulopathy, or INR >1.5.
21. Any thrombolytic therapy within 2 weeks of the index procedure.
22. Any clinical and/or angiographic complication attributed to the use of another device prior to the insertion of the Pantheris into the subject.
23. Subjects or their legal guardians who have not or will not sign the Informed Consent.
24. Subjects who are unwilling or unable to comply with the follow-up study requirements.
25. Participation in any study of an investigational device, medication, biologic or other agent within 30 days prior to enrollment that is either a cardiovascular study or could, in the judgment of the investigator, affect the results of the study.