{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T19:46:33Z","timestamp":1788205593307,"version":"build-2803163510"},"reference-count":51,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T00:00:00Z","timestamp":1767139200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Medicine and Pharmacy Carol Davila"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Drug-coated balloons (DCBs) have emerged as an alternative to drug-eluting stents (DESs) in percutaneous coronary intervention, delivering antiproliferative drugs without leaving a permanent implant. This review provides a comparative analysis of sirolimus-coated DCBs (DCB-S), paclitaxel-coated DCBs (DCB-P), and DESs across key scenarios: de novo coronary lesions in chronic coronary syndrome (CCS), acute coronary syndromes (ACS), and in-stent restenosis (ISR). We discuss late lumen loss (LLL), target lesion\/vessel revascularization (TLR\/TVR), vessel patency, and major adverse cardiac events (MACE) outcomes, along with current guidelines and emerging indications for DCB-S. We also examine pharmacological differences between sirolimus and paclitaxel (mechanisms of action, tissue uptake, and healing profiles), trial methodologies, and recent innovations in DCB technology. Across stable de novo lesions (especially small vessels and high bleeding-risk patients), multiple trials show DCB-P can achieve non-inferior clinical outcomes to DES. Early data suggest newer DCB-S may likewise match DES outcomes in broader populations. In ACS, DCB-only strategies have demonstrated feasibility and safety in carefully selected lesions without heavy thrombus, with randomized studies like REVELATION (STEMI) showing non-inferior fractional flow reserve and low revascularization rates compared to DES. For ISR, DCB-P is an established Class I treatment in both BMS-ISR and DES-ISR, yielding similar or lower TLR rates than repeat stenting. DCB-S are now being evaluated as an alternative in ISR, aiming to avoid additional stent layers. Contemporary guidelines endorse DCB use in ISR and small vessels, and experts anticipate expanding indications as evidence grows. Sirolimus and paclitaxel differ in antiproliferative mechanisms and pharmacokinetics\u2014sirolimus (cytostatic, mTOR inhibition) may offer faster endothelial recovery, whereas paclitaxel\u2019s high lipophilicity ensures sustained arterial wall retention. Technological advances (e.g., phospholipid micro-reservoirs for sirolimus) are enhancing drug transfer and addressing prior limitations. In summary, DCB-P and DCB-S now represent viable alternatives to DES in specific scenarios, especially where \u201cleaving nothing behind\u201d could reduce long-term complications. Ongoing large randomized trials, such as SELUTION DeNovo, currently available as conference-presented data, together with longer-term follow-up will further clarify the optimal niches for DCB-S versus DCB-P and DES.<\/jats:p>","DOI":"10.3390\/life16010063","type":"journal-article","created":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T16:34:23Z","timestamp":1767198863000},"page":"63","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Paclitaxel- and Sirolimus-Coated Balloons Versus Drug-Eluting Stents in Coronary Artery Disease: A Comprehensive Narrative Review"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4575-766X","authenticated-orcid":false,"given":"Flavius-Alexandru","family":"Gherasie","sequence":"first","affiliation":[{"name":"Department of Cardiology, University of Medicine and Pharmacy \u201cCarol Davila,\u201d 050474 Bucharest, Romania"},{"name":"Emergency Clinical Hospital Dr. Bagdasar-Arseni, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Al Hassan","family":"Ali","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Medicine and Pharmacy \u201cCarol Davila,\u201d 050474 Bucharest, Romania"},{"name":"Department of Cardiology, Elias University Emergency Hospital, 011461 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Maria","family":"Corzanu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Medicine and Pharmacy \u201cCarol Davila,\u201d 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva Catalina","family":"Costescu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Medicine and Pharmacy \u201cCarol Davila,\u201d 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonia-Gabriela","family":"Cornea","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Medicine and Pharmacy \u201cCarol Davila,\u201d 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1016\/S0140-6736(18)31719-7","article-title":"Drug-Coated Balloons for Small Coronary Artery Disease (BASKET-SMALL 2): An Open-Label Randomised Non-Inferiority Trial","volume":"392","author":"Jeger","year":"2018","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2840","DOI":"10.1016\/j.jcin.2020.08.035","article-title":"Drug-Coated Balloon Versus Drug-Eluting Stent for Small Coronary Vessel Disease","volume":"13","author":"Cortese","year":"2020","journal-title":"JACC Cardiovasc. 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