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Conventional drug\u2010eluting stents (DES) show limited efficacy due to enhanced neointimal proliferation, microvascular dysfunction, and impaired endothelial healing. This narrative review synthesizes contemporary evidence on drug\u2010coated balloon (DCB) angioplasty efficacy, safety, and procedural strategies in diabetic small vessel disease (SVD). A comprehensive literature search of PubMed, Scopus, and Web of Science was conducted through October 2025, focusing on randomized controlled trials, meta\u2010analyses, registries, and physiological studies comparing DCBs and DES in diabetic SVD. Recent trials (BELLO, Dissolve\u2010SVD, BASKET\u2010SMALL 2, PICCOLETO II) and meta\u2010analyses indicate DCBs achieve non\u2010inferior or superior angiographic outcomes versus DES in diabetic SVD, particularly regarding late lumen loss, restenosis, and vessel thrombosis. Procedural advantages include endothelial function preservation, reduced inflammation, and significantly shorter dual antiplatelet therapy duration\u2014crucial for high\u2010bleeding\u2010risk diabetic populations. DCB angioplasty represents a promising \u201cleave\u2010nothing\u2010behind\u201d revascularization strategy for diabetic small vessels, combining efficacy with enhanced vascular healing and safety. Ongoing sirolimus\u2010coated technology developments and future diabetes\u2010focused trials are expected to refine its interventional role.<\/jats:p>","DOI":"10.1002\/ccd.70550","type":"journal-article","created":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T03:41:13Z","timestamp":1773632473000},"page":"1922-1933","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Revolutionizing Modern Percutaneous Coronary Intervention: Drug\u2010Coated Balloons for Diabetics With Small Vessel Disease. 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