Background and Aims Thoracic outlet decompression with a subclavian artery bypass is considered to be the standard surgical procedure for arterial thoracic outlet syndrome (TOS), and it requires different surgical approaches for different locations of arterial compression. The efficacy of above surgery is reliable, and the long-term functional prognosis of the affected limb is usually satisfactory after surgery. However, above surgical procedure is technically difficult with a long learning curve, and will result in great trauma and many complications such as bleeding and nerve damage, as well as slow recovery of patients after the surgery. In recent years, the advancement of endovascular technology and the innovation of vascular devices have enabled a considerable number of vascular stenotic lesions to be effectively treated by interventional surgery. However, there are few previous reports on the use of endovascular techniques for the treatment of arterial TOS. Therefore, this study was to investigate the primary clinical efficacy of Rotarex mechanical debulking combined with drug-coated balloon (DCB) dilatation for arterial TOS, aiming to provide a new and reliable treatment approach for this condition.Method The clinical data of 6 patients with arterial TOS who underwent Rotarex mechanical debulking combined with DCB dilatation from January 2019 to December 2021 in Beijing Jishuitan Hospital were retrospectively analyzed. The surgical success rate, operative time, length of hospitalization, and surgical complications as well as the arterial patency rate and revascularization rate of the target lesion on postoperative 3 months were analyzed. The cervical brachial symptom and McGill pain questionnaire scores as well as the radial-artery pulses of the patients before and after operation were compared.Results In the 6 patients, the surgical success rate was 100%, the mean operative time was (52.3±18.7) min, mean length of hospitalization was (5.7±1.6) d, and mean intraoperative blood loss was (31.5±20.7) mL. There were no surgery-related complications. Three months after operation, the artery patency rate was 100%, and the revascularization rate of the target lesion was 16.67%. The postoperative cervical brachial symptom of the patients was significantly lower than that before operation (59.3±17.3 vs. 83.1±11.2, P<0.05), but the McGill pain questionnaire score of the patients showed no statistical difference with that before operation (45.3±12.5 vs.51.9±9.2, P>0.05), and the postoperative radial-artery pulse of the patients was significantly improved compared with preoperative status (P<0.05).Conclusion Rotarex mechanical debulking combined with DCB dilatation is a minimally invasive, safe and effective method for the treatment of arterial TOS with a satisfactory short-term effect. However, the indications for endovascular surgery should be strictly controlled, and the TOS patients undergoing this procedure should be carefully selected, and meanwhile timely follow-up is also needed. The mid- and long-term efficacy of this treatment method remains to be further observed.