Peripheral arterial disease in (PAD) is a condition that affects a large number of patients, with well-known increase incidence of cardiovascular events as well as decreased quality of life an increased risk of amputation. Atherosclerosis disease is the most common cause of obstructed PAD. In addition to medical treatment to preventing cardiovascular disease, revascularization has been the cornerstone treatment for symptomatic patients and those with critical limb ischemia. Endovascular treatment for PAD has evolved over the last three decades and is currently the first line of treatment for symptomatic patients and those with critical limb ischemia [ ]. However, it is important to emphasize that the superficial femoral and popliteal arteries (SFA/popliteal) remain challenging locations for endovascular treatment [ , ]. Multiple reasons have been described, including the diffuse nature of the disease, long lesions and the presence of calcification that increase the chances of dissection and the need for stents. Conventional stents are not ideal for treating the SFA/popliteal lesions due to the bending, shortening, elongation, and twisting of the artery, which can lead to stent fracture and higher restenosis rates [ ]. Treating in-stent restenosis is particularly challenging, with poor long-term outcomes observed with most alternative treatments for long and diffuse in-stent restenosis. Consequently, there is a need for treatments that prevent dissection and minimize the use of long stents. While various atherectomy devices have been used in long SFA/popliteal lesions, showing decreased dissection and the need for stents, restenosis rate remains high [ ].