The goal of this clinical trial is to learn if using a scoring balloon to prepare the femoropopliteal (FP) segment before drug-coated balloon treatment works better than using a regular balloon (called plain old balloon angioplasty, or POBA). This study includes only people with critical limb ischemia (CLI). The main questions it aims to answer are: 1. Does using a scoring balloon reduce the need for a bailout stent during the procedure? 2. Does a scoring balloon help keep the artery open longer? 3. Is the cost of the scoring balloon procedure similar to the cost of the POBA procedure? Participants will: * Receive either a scoring balloon or POBA to prepare the femoropopliteal segment * Then be treated with a drug-coated balloon in the same segment * Be monitored during the procedure to see if a bailout stent is needed * Have follow-up visits to see if the artery remains open
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Bailout stenting
Timeframe: At index procedure
Primary patency
Timeframe: 12 months