The objective of this study is to establish reasonable assurance of safety and effectiveness of the Golazo® Peripheral Atherectomy System when used as indicated in 159 subjects with symptomatic infrainguinal peripheral arterial disease (PAD) in up to 20 investigational sites in the U.S.

The investigation is a prospective, multicenter, non-randomized, single-arm, open-label pivotal clinical study. Subjects will undergo atherectomy treatment with the Golazo® Peripheral Atherectomy System and will then be followed 6-months post-procedure.

General inclusion criteria:

1. Age ≥18 years

2. Candidate for atherectomy of the peripheral vasculature in the lower limbs

3. Life expectancy >1 year in the opinion of the investigator

4. Resting ankle brachial index (ABI) ≤0.90, or ≤0.75 after exercise. Subjects with non-compressible arteries shall have a toe brachial index (TBI) assessment.

5. Target limb Rutherford clinical classification category 3 to 5

6. Suitable candidate for angiography and endovascular intervention in the opinion of the investigator

7. Willing and able to comply with the protocol-specified procedures and assessments

8. Informed consent granted

   Angiographic inclusion criteria:

9. Target lesion(s) defined as stenosis ≥70% by angiographic visual estimation

10. Total treated lesion length ≤20 cm by angiographic visual estimation

11. Target reference vessel diameter (RVD) ≥2.0 mm and ≤4.5 mm by angiographic visual estimation

12. Target limb will have a minimum of one patent (less than 50% stenosis) below the knee (BTK) vessel crossing the ankle, distal to any target lesion, providing perfusion to the foot at baseline

General exclusion criteria:

1. Active infection in the target limb

2. History of an endovascular procedure or open vascular surgery on the target limb within the last 30 days

3. Planned surgical or interventional procedure within 30 days after the index procedure

4. Lesion in the contralateral limb requiring intervention during the index procedure or within next 30 days

5. Critical limb ischemia (CLI) with Rutherford clinical classification category 6

6. Significant acute or chronic kidney disease with a GFR <30 and/or requiring dialysis

7. Acute myocardial infarction (non-ST-elevation myocardial infarction or ST-segment elevation myocardial infarction) or other uncontrolled comorbidity in the opinion of the investigator

8. Myocardial infarction (MI) or stroke within two months of baseline evaluation

9. Pregnant or lactating

10. Subject is participating in another clinical investigation of a device, drug, or procedure that has not completed the study treatment or that clinically interferes with the endpoints of this study (post-approval registries are allowed as long as the investigator determines there is no clinical interference with study endpoints)

11. Contraindication to antiplatelet, anticoagulant, or thrombolytic therapy

12. Uncorrectable bleeding diathesis, platelet dysfunction, thrombocytopenia with platelet count <125,000/microliter, known coagulopathy, or international normalized ratio (INR) >1.5

13. Known allergy to contrast agents or medications used to perform endovascular intervention that cannot be adequately medicated

14. History of heparin-induced thrombocytopenia (HIT)

15. Any thrombolytic therapy within two weeks of enrollment

16. Target lesion(s) within a native vessel graft or synthetic graft

17. Significant stenosis or occlusion of inflow not successfully treated before the index procedure

18. Any evidence or history of intracranial or gastrointestinal bleeding or intracranial aneurysm

19. Vulnerable subject populations (e.g., incarcerated or cognitively challenged adults)

20. One or more of the following complications of the foot:

    1. Osteomyelitis that extends to the metatarsal bones.
    2. Gangrene involving the plantar skin of the forefoot, midfoot or heel
    3. Deep ulcer or large shallow ulcer (>3cm) involving the plantar skin of the forefoot, midfoot, or heel
    4. Any heel ulcer with/without calcaneal involvement
    5. Any wound with calcaneal bone involvement
    6. Wounds that are deemed to be neuropathic or non-ischemic in nature
    7. Wounds that require flap coverage or complete wound management for large soft tissue defect

21. Congestive heart failure with a NYHA functional classification of III or higher

    Angiographic exclusion criteria:

22. More than 2 lesions to be treated with the investigational device; lesions located within 3 mm may be considered a single tandem lesion

23. Clinical/angiographic complication (other than non-flow limiting dissections) attributed to a currently marketed device prior to introduction of the investigational device

24. In-stent restenosis within the target lesion(s)

25. Potentially unstable or flow-limiting dissection, type C or greater

26. Clinical/angiographic evidence of distal embolization

27. Inability to cross the proximal lesion vessel lumen with a guidewire (not subintimal)