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Background: Endovascular mechanical atherothrombectomy (MATH) is the technique that removes occlusive masses from vessel lumen. In patients with in-stent arterial occlusions, this modality can exclude or reduce the wall barotrauma associated with balloon angioplasty, necessity of additional stent implantation and the risk of open surgery. However, adoption of MATH has been slow mainly due to limited experience with the technique. Method/results: The purpose of this minireview is to present a pictorial anatomic series of managed lesions and immediate therapeutic results documented angiographically. This may help the reader to select efficient technique for safe and successful treatment even in difficult anatomic conditions. Conclusion: Endovascular mechanical atherectomy with the Rotarex catheter can be helpful in recanalization of lower limbs arterial in-stent occlusions. It can be used also when other therapeutic modalities are risky or inefficient. [ABSTRACT FROM AUTHOR]