Background: Artisanal fisheries in the Mediterranean, especially in Italy, have been poorly investigated. There is a long history of fishing in this region, and it remains an important economic activity in many localities. Our research entails both a comprehensive review of the relevant literature and 58 field interviews with practitioners on plants used in fishing activities along the Western Mediterranean Italian coastal regions. The aims were to record traditional knowledge on plants used in fishery in these regions and to define selection criteria for plant species used in artisanal fisheries, considering ecology and intrinsic properties of plants, and to discuss the pattern of diffusion of shared uses in these areas. Methods: Information was gathered both from a general review of ethnobotanical literature and from original data. A total of 58 semi-structured interviews were carried out in Liguria, Latium, Campania and Sicily (Italy). Information on plant uses related to fisheries were collected and analyzed through a chi-square residual analysis and the correspondence analysis in relation to habitat, life form and chorology. Results: A total of 60 plants were discussed as being utilized in the fisheries of the Western Italian Mediterranean coastal regions, with 141 different uses mentioned. Of these 141 different uses, 32 are shared among different localities. A multivariate statistical analysis was performed on the entire dataset, resulting in details about specific selection criteria for the different usage categories (plants have different uses that can be classified into 11 main categories). In some uses, species are selected for their features (e.g., woody), or habitat (e.g., riverine), etc. The majority of uses were found to be obsolete (42%) and interviews show that traditional fishery knowledge is in decline. There are several reasons for this, such as climatic change, costs, reduction of fish stocks, etc. Conclusions: Our research correlates functional characteristics of the plants used in artisanal fishery and habitats, and discusses the distribution of these uses. This research is the first comprehensive outline of plant role in artisanal fisheries and traditional fishery knowledge in the Mediterranean, specifically in Italy.