An atherectomy system having a variably exposed cutter wherein a distally located positionable tip closely associated with the cutter and a high pressure fluid jet emanator can be variably and angularly deployed about a hinge mechanism subsequent to entry into the vasculature. The fixed cutter slices or parts atheromatous material and/or thrombotic material from a blood vessel for interaction with high pressure jets to macerate, break up or otherwise reduce the materials for evacuation from the site.