Chronic upper limb ischemia is uncommon, and is most often secondary to subclavian artery stenosis. Percutaneous intervention for subclavian stenosis usually includes balloon angioplasty and stent implantation. Brachial artery stenosis is even more scarce and accounts for approximately 12% of symptomatic upper extremity ischemia. Because it is rare, the optimal treatment strategy for brachial artery stenosis remains uncertain. We describe a case of chronic brachial artery ischemia due to atherosclerotic disease treated with the SilverHawk plaque excision system and review the available data regarding its use.