We retrospectively reviewed the clinical data of 217 consecutive Chinese patients with isolated atherosclerotic popliteal artery lesions treated with atherectomy technique, DCB, and plain old balloon angioplasty from August 2017 to August 2022. There was no difference in the 48-month patency rate between the atherectomy, DCB, and POBA groups (65%, 56%, and 51%, respectively; p = 0.3), as well as in adjusted Cox regression. Similarly, no difference was observed in the 48-month clinically driven target lesion revascularization-free (CDTLR-free) rate among the groups (77%, 74%, and 65%; p = 0.34), confirmed by adjusted Cox regression. In the 48 months, a significant difference was observed in amputation-free rates between the atherectomy, DCB, and POBA groups (97%, 91%, and 83%, respectively; p < 0.05). Adjusted Cox regression indicated POBA had worse outcomes than DCB and atherectomy. In the stenosis and occlusion subgroup, the 48-month primary patency rates were 65%, 70%, and 54% (p > 0.9) and 65% versus 49% versus 49% (p = 0.3), showing no differences among the three groups. In the short lesion subgroup (<10 cm), the 48-month primary patency rates were 65%, 66%, and 61% for atherectomy, DCB, and POBA, respectively (p = 0.7). In the long lesion subgroup (≥10 cm), the 48-month patency rates were higher in the atherectomy and DCB groups compared to POBA (64%, 44%, and 34%), with no significant difference among the groups (p = 0.13). DCB and atherectomy demonstrate improved short- and mid-term clinical outcomes compared to POBA in Chinese patients with popliteal artery disease.© 2024 The Author(s). The Journal of Clinical Hypertension published by Wiley Periodicals LLC.