Complete Lesion Assessment With ffR and IVUS TechnologY

This prospective, randomized, multi-center, post-market study of approximately 50 subjects
randomized 1:1 to Orbital Atherectomy (OA) performed with Cardiovascular Systems, Inc.'s
Orbital Atherectomy System (OAS) followed by adjunctive balloon angioplasty (BA) vs. BA alone
for treatment of tibial vessel disease, defined as ≥ 50 % stenosis of the anterior tibial
(AT), posterior tibial (PT), tibial peroneal trunk (TPT), or peroneal (PR) arteries by
angiography. All subjects will have a corresponding wound being fed by the target vessel
which will be assessed during the study. Subjects will be followed to one year.

General Inclusion Criteria:

1. Subject's age ≥ 18 years.

2. Subject is an acceptable candidate for percutaneous intervention with the Sponsor's
OAS and BA in accordance with their labeled indications and instructions for use.

3. Subject is willing and able to sign an approved informed consent form (ICF).

4. Subject is willing and able to attend follow-up and wound care visits.

General Exclusion Criteria:

1. Subject is pregnant or planning to become pregnant within the study period.

2. Subject is currently participating in an investigational drug or other device study
that can clinically interfere with the endpoints of this trial.

3. Subject has a known sensitivity to contrast media and the sensitivity cannot be
adequately pre-medicated.

4. Uncontrolled allergy to nitinol, stainless steel, or other stent materials.

5. Subject has known allergy to atherectomy lubricant components such as soybean oil, egg
yolk phospholipids, glycerin or sodium hydroxide.

6. Subject has a history of bleeding diathesis or coagulopathy or will refuse blood
transfusions.

7. Subject has been diagnosed with chronic renal failure or has a creatinine level > 2.5,
unless on dialysis, prior to the index treatment.

8. Subject has evidence of intracranial or gastrointestinal bleeding within 90 days.

9. Subject has a history of trauma, fracture, major surgery (includes major amputation),
or biopsy of a parenchymal organ within past 14 days, or patient has not healed from a
previous medical intervention occurring more than 14 days.

10. Subject has a history of stroke or myocardial infarction (MI) within 90 days prior to
enrollment in the study.

11. Subject has a planned major surgery (includes major amputation) scheduled within 60
days after treatment of the index limb.

12. Subject has a planned interventional treatment to address stenosis of the
contralateral limb scheduled within 60 days after the index treatment.

13. Subject has a planned interventional treatment to address inflow stenosis of the
ipsilateral limb scheduled within 60 days after the index treatment.

14. Inflow or bilateral PAD requiring treatment prior to enrollment was not successfully
treated, defined as > 50% residual stenosis and/or occurrence of procedural
angiographic complications, excluding dissection types A and B.

15. Subject has previously had their other limb treated as part of the study.

Angiographic Inclusion Criteria:

1. Target lesion(s) located in the anterior tibial (AT), posterior tibial (PT), tibial
peroneal trunk (TPT) or peroneal (PR) arteries.

2. Target lesion has ≥ 50 % stenosis by angiography.

3. Subject has a corresponding wound being fed by the target vessel.

Angiographic Exclusion Criteria:

1. Target limb does not have any visual flow to the foot confirmed via distal selective
angiography.

2. Thrombus is present or suspected in the target treatment vessel.

3. Target lesion is within a bypass graft or near a previously placed stent.

4. The guide wire cannot be passed across the target lesion.

5. Anterograde access of the lesion is not possible.

6. Subject has angiographic evidence of significant dissection at or near the treatment
site.

7. Interventional treatment is intended for in-stent restenosis at the peripheral
vascular site.

8. Subject's wound(s) involve multiple angiosomes.