The Rotarex® and Aspirex® are newly developed over-the-wire rotational thrombectomy catheters. These devices combine mechanical clot fragmentation and active negative-pressure removal of thrombus particles to prevent distal embolization. Several successful in vitro studies have been followed by the pursuit of different applications, and the device has been used successfully in the treatment of acute to chronic thrombo-embolic arterial occlusions in the limbs, hemodialysis access grafts, bypasses, stents, pulmonary artery occlusion, and inferior vena cava and aortohepatic bypass occlusions. Widespread clinical use so far has not been achieved, and more specific indications must be identified to extend the experience with the Rotarex® and Aspirex® devices.