Sirolimus- vs. Paclitaxel-Drug Coated Ballons in Patients With Peripheral Artery Disease

Inclusion Criteria: 1. Subject age ≥ 18 2. Subject has been informed on the nature of the study, the duration of the study, agrees to attend follow-up visits, agrees to complete the required testing, agrees to participate, and has signed an informed consent form. 3. Rutherford category 2-4 according to the investigator's subjective evaluation 4. Subject has a de novo or re-stenosed lesion with ≥ 70 % stenosis documented angiographically 5. Target lesion length is ≥ 2 cm and ≤ 20 cm by visual estimate of the treating physician 6. Multiple lesions with max. 3 cm healthy vessel segment in between lesions can be considered at the discretion of the operator as one lesion. Total lesion length should not exceed 20 cm 7. Reference vessel diameter (RVD) ≥ 4 mm and ≤ 6.5 mm by visual estimation 8. Patency of P2 and P3 segment of the popliteal artery and at least one (1) infrapopliteal artery to the ankle (\< 50 % diameter stenosis) in continuity with the femoropopliteal artery 9. Patency of ipsilateral iliac artery (≤ 30% diameter stenosis). Iliac artery stenosis \> 30 % may be treated during the index procedure to ensure sufficient inflow. 10. A guidewire has successfully traversed the target treatment segment intraluminal 11. Vascular disease in the opposite leg that requires treatment at the time point of index procedure is allowed, but has to be treated according to randomization or with POBA. 12. A patient can only be enrolled and randomized once with only one target lesion in the SIRONA trial. Please note that only the lesion in one limb can be treated as target lesion for index procedure. Exclusion Criteria: 1. Failure to successfully cross the target lesion or subintimal target lesion guidewire crossing 2. Flow-limiting dissection after pre-dilatation 3. Angiographic evidence of severe calcification of the target vessel (contiguous calcification on both sides of the vessel) 4. Presence of fresh thrombus in the target lesion 5. Presence of aneurysm in the target vessel/s 6. Prior vascular surgery (including atherectomy, bypass surgery) of the target limb 7. Prior stent in the target lesion 8. Stroke or heart attack within 3 months prior to enrollment 9. Any vascular surgical procedure or intervention performed in the target limb within 30 days prior to or planned within 30 days post index procedure 10. Any vascular treatment with PTX or sirolimus-coated devices 60 days prior to index procedure 11. Target lesion requires treatment with alternative therapies such as primary stenting, laser, lithotripsy, thrombectomy, atherectomy, cryoplasty, brachytherapy, re-entry devices 12. Enrolled in another investigational drug, device or biologic study 13. Life expectancy of less than one year in the investigator's opinion 14. Known allergies or sensitivity to heparin, aspirin, other anticoagulant/ antiplatelet therapies, sirolimus, paclitaxel or contrast media that cannot be adequately pre-treated prior to index procedure 15. Significant gastrointestinal bleeding or any coagulopathy that would contraindicate the use of anti-platelet therapy 16. Receiving dialysis or immunosuppressant therapy 17. Pregnant or lactating females 18. History of major amputation in the same limb as the target lesion