Drug-coated Balloon Angioplasty Versus Drug-eluting Stenting for Femoropopliteal Arterial Disease: A Review of the Current Status

Endovascular procedures are frequently performed for symptomatic femoropopliteal disease. Drug-eluting stents (DES) and drug-coated balloons (DCB) were introduced to improve long-term outcomes and demonstrated superior outcomes to percutaneous transluminal angioplasty in randomised clinical trials. Femoropopliteal disease, however, can be challenging to treat using an endovascular approach as this segment suffers increased biomechanical stress during extremity movements, which may lead to chronic vascular injury or even stent fracture. The advantages of DCB include the direct and homogeneous delivery of an antiproliferative agent to the arterial wall, and the ability to reach tortuous and longer lesions without a vascular implant; however, the lack of scaffold makes the intervention prone to significant recoil. Even though the use of DCB, a leave-nothing-behind strategy, may appear desirable, the need for bailout stenting will increase as lesions become more complex. This review summarises and compares the currently available evidence regarding the use of DCB and DES in the treatment of femoropopliteal disease.