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Embolic protection should be considered in carotid artery invasive management.Thrombectomy in ischemic stroke provides better functional outcome.Vertebral stenosis may be treated only if symptoms re-occur under medical treatment.Revascularization is not routinely recommended in renal artery stenosis.Invasive PAD treatment (versus surgery) offers lower periprocedural complications.Invasive treatment in peripheral artery disease (PAD) has evolved as a viable alternative to surgical treatment. However, beyond the common pathophysiological substrate, as far as treatment is concerned, each site of atherosclerotic disease (subclavian and vertebral arteries; carotid arteries; intracranial arterial tree; renal arteries; lower extremity arteries) features unique characteristics. Treatment options include medical treatment, endovascular management and/or surgery. Sound clinical evaluation is required as individual patient assessment often limits intervention options, while available data regarding benefits of invasive and surgical management are questioned by advances in medical treatment. In the present article, we aim to summarize existing evidence and guidance on the role of invasive procedures in PAD.