This paper will discuss the results from the most recent randomized trials and large registries for DCB's and atherectomy, and the drawbacks of these two therapeutic options. It will also discuss the results of combination therapy in complex femoropopliteal lesions. Several studies indicate that combining atherectomy and DCB yields better outcomes in complex calcified lesions, but the only randomized pilot study could not demonstrate a benefit of combination therapy in the mid-term follow-up. Larger, randomized studies are needed to define the role of atherectomy followed by DCB angioplasty further.