Recent advances in endovascular technology have generated a variety of alternative procedures and instruments in treating peripheral arterial occlusive disease. Mechanical atherectomy has been developed as an alternative to conventional percutaneous transluminal angioplasty (PTA) because of its limitations. Atherectomy devices can selectively remove atheroma by cutting or pulverising it in atherosclerotic diseased arteries percutaneously with angiographic guidance or openly through a small arteriotomy distant from the diseased site under fluoroscopic or angioscopic control. Theoreticall3~ atherectomy offers three advantages over PTA: (1) greater immediate success rate with lower rates of intimal dissection and acute occlusion due to the controlled removal of atheroma from the lumen; (2) wider application to complex lesions not readily amenable to PTA; and (3) reduction of restenosis rate due to the debulking of atheromatous mass. There are currently two types of atherectomy devices: extirpative and ablative. Extirpative atherectomy is characterised by shaving, cutting, or directly removing atheroma and collecting the excised material from the vessel lumen and wall. Ablative atherectom~ on the other h a n g uses a high-speed rotational device to pulverise atheroma into fragments small enough to be aspirated or removed through the reticuloendothelial system. Among the numerous atherectomy devices currently available, only four have undergone extensive clinical trials: the extirpative catheters-the Simpson Atherocath and the