Safety and Effectiveness Study of Eximo's B-Laser™ Atherectomy Device for PAD Treatment

The aim of the study is to assess the safety and efficacy of the use of the Eximo's B-Laser™ catheter in subjects affected with Peripheral Artery Disease (PAD) in lower extremity arteries.

This is a prospective, single-arm, multi-center, international, open-label, non-randomized clinical study.

All enrolled subjects will undergo atherectomy procedure, during which the B-Laser™ catheter will be used to perform atherectomy in target lesion, followed by any other adjunctive therapy (balloon and/or stent etc.). The procedure will be done according to standard hospital procedure for atherectomy. The steps of the operation before and after the operating of the B-Laser™ device are routinely used practice and will be done according to local practice at each hospital. For the post-atherectomy stage, as an adjunctive therapy in the procedure, any approved device may be used (balloon and/or stent etc.).

Subjects will then be followed for 12 months after the procedure.

Eligibility Criteria:
Inclusion Criteria:

1. Subject is ≥ 18 years old.
2. Subject is a candidate for endovascular intervention for peripheral artery disease in the lower extremities.
3. Documented symptomatic atherosclerotic peripheral artery disease Rutherford Classification 2-4.
4. Subject has infrainguinal target lesion(s) with any type of stenosis (naïve or recurrent) estimated to be ≥70% based on CT angiogram or other imaging modality.
5. At least one patent tibial run-off vessel at baseline.
6. Subject is capable and willing to comply with the scheduled follow up.
7. Subject is able and willing to sign a written informed consent form (ICF).

Intraoperative inclusion criteria (by fluoroscopy angiogram):

1. Reference vessel lumen diameter proximal to target lesion is ≥150% of the outer diameter of the B-Laser™ to be used.
2. Target lesion has been crossed with a guidewire within the true lumen.
3. Target lesion has a stenosis estimated to be ≥70%.

Exclusion Criteria:

1. Target lesion is in a vessel graft or synthetic graft.
2. Target lesion length \>25 cm.
3. Endovascular or surgical procedure performed less than or equal to 30 days prior to the index procedure OR Planned endovascular or surgical procedure 30 days after the index procedure.
4. Intent to use other atherectomy device in the same procedure.
5. Flow limiting dissection proximal to, distal to or in the target lesion.
6. Evidence or history of intracranial or gastrointestinal bleeding, intracranial aneurysm, myocardial infarction or stroke within the past 2 months.
7. Evidence or history of aneurysm in the target vessel within the past 2 months.
8. History of bleeding diathesis, coagulopathy or inability to accept blood transfusions.
9. History of heparin-induced thrombocytopenia (HIT).
10. Significant acute or chronic kidney disease with a creatinine level \>2.5 mg/dl, and/or requiring dialysis.
11. Any thrombolytic therapy within 2 weeks of the index procedure.
12. History of severe trauma, fracture, major surgery or biopsy of a parenchymal organ within the past 14 days.
13. Known allergy to contrast agents or medications used to perform endovascular intervention that cannot be adequately pre-treated.
14. Subjects in whom anti-platelet, anticoagulant, or thrombolytic therapy is contraindicated.
15. Serious illness that may affect subject compliance to protocol and at a minimum the 30-day follow-up.
16. Participating in other clinical study that involves any kind of intervention, including pharmaceutical.
17. Issue that in the judgment of the investigator, may affect the results of the study.
18. Subject is pregnant or planning to become pregnant during the study period.

Intraoperative exclusion criteria (by fluoroscopy angiogram):

1. Total occlusion of the Target lesion that cannot be crossed in the true lumen by 0.014" GW.
2. Target lesion length \>25 cm.
3. Reference vessel lumen diameter proximal to target lesion is \<150% of the outer diameter of the B-Laser™.
4. Any clinical and/or angiographic complication attributed to the use of another device prior to the study procedure.
5. Flow limiting dissection proximal, distal or in the target lesion.