Purpose Effective vessel preparation in lower limb revascularisation is an important consideration for limb preservation. Peripheral atherectomy, such as Stealth, uses a rotating crown to debulk calcification to reduce complications including dissections and bail-out stenting (1). This study evaluated the safety and effectiveness of Stealth atherectomy. Methodology A retrospective cohort study was performed in a regional tertiary vascular centre. Outcome measures included primary patency, major adverse limb events, wound healing and complications. Results: Of the 40 patients (mean age 71 ±10, 78% male), 50% were ex-smokers with one-third current smokers. For Rutherford grading: 40% of patients were 3, 37% 5, 12% 4. 60% had intervention for CFA and SFA disease. Most lesions were calcific, eccentric plaques with average stenosis of 75-90%, and mean lesion length 101mm. Procedures were performed mostly via contralateral retrograde femoral access with an Emboshield. 2 patients required bailout stenting. 90% of patients had residual stenosis <50% angiographically. 3 cases had embolisation to tibial vessels requiring suction thrombectomy, and closure device failure occurred in one case requiring open repair. At mean 6-month follow-up, 78% of interventions had primary patency, with 10% requiring reintervention. Improvement in wound healing and amputation-free survival was noted in 94% of cases. 8 cases required reintervention due to ongoing calcification. Only two patients had major limb amputation within one year. One acute coronary event occurred with no procedure-related deaths. Conclusion The use of Stealth was associated with good technical success rates which correlated favourably with wound healing and excellent rates of lower limb salvage. Complications and the use of bail out stenting were low, however, data from long term outcomes is required to support its use for lower limb salvage. Giannopoulos S, et al. J Endovasc Ther. 3-year outcomes of orbital atherectomy