Background: Peripheral arterial disease (PAD) affects up to 200 million people worldwide, most commonly in the femoropopliteal segment. Despite advancements in endovascular therapy, high rates of restenosis and reintervention persist. Atherectomy, utilising directional (DA) or rotational (RA) devices, has been proposed as a solution to address these challenges. This study aims to describe long-term outcomes of DA and RA in treating femoropopliteal lesions. Methods: This single-centre, retrospective study included patients who underwent femoropopliteal atherectomy between January 2019 and July 2024. Lesions were classified using Trans-Atlantic Inter-Society Consensus Document (TASC) criteria. The primary outcome was primary patency at 12 months. Secondary outcomes included technical success, 30-day mortality, target lesion revascularisation (TLR), and major and minor amputations. Data was analysed via t-test and χ2. Kaplan-Meier survival analyses were performed for survival, amputation-free survival, primary patency, and freedom from TLR. Results: 60 lesions in 55 patients were treated with atherectomy and drug-coated balloon angioplasty (DCB), 31 via DA and 29 via RA. Baseline characteristics were similar between groups. 12-month primary patency was 80.7% for DA and 89.7% for RA (p=0.33). TLR was 6.5% for DA and 6.9% for RA (p=0.95). No significant difference was seen in 30-day mortality or survival, amputation-free survival, primary patency, or reintervention. Conclusion: Both DA and RA devices demonstrate comparable outcomes in femoropopliteal lesions. The choice between DA and RA should consider operator experience and device availability. Prospective studies are required to further explore device-specific outcomes.