If you’ve been diagnosed with peripheral artery disease (PAD) and your doctor has recommended an endovascular procedure to restore blood flow to your legs, you may have heard terms like “angioplasty,” “stent,” and “drug-coated balloon.” These are all tools in the modern vascular specialist’s toolkit—but they work differently, and understanding the distinctions can help you have a more informed conversation with your care team.
At Surgical Associates, our vascular specialists use the full range of endovascular technologies to treat PAD. Here’s what you should know about two of the most important advances: drug-coated balloons (DCBs) and drug-eluting stents (DES).
The Problem They Both Solve: Restenosis
Standard balloon angioplasty—sometimes called “plain old balloon angioplasty” or POBA—has been used for decades. A deflated balloon is threaded to the narrowed artery, inflated to push the plaque against the artery wall, then removed. It works, but it has a limitation: the artery often re-narrows over time, a process called restenosis. In the femoropopliteal artery (the main artery in the thigh), restenosis rates after plain balloon angioplasty can be as high as 40–60% within the first year.
Bare metal stents were introduced to address this by propping the artery open with a permanent scaffold. This improved patency rates but introduced new problems: the artery’s healing response sometimes caused tissue to grow through the stent mesh (in-stent restenosis), and in arteries that bend and flex—like the superficial femoral artery behind the knee—stents can fracture over time.
Both drug-coated balloons and drug-eluting stents tackle restenosis by delivering anti-proliferative medication (usually paclitaxel) directly to the artery wall, inhibiting the smooth muscle cell growth that causes re-narrowing.
Drug-Coated Balloons: How They Work
A DCB looks like a standard angioplasty balloon, but its surface is coated with a thin layer of paclitaxel mixed with an excipient that helps the drug transfer to the artery wall during inflation. When the balloon is inflated and held in place for 60–180 seconds, the medication is deposited into the vessel wall. The balloon is then deflated and removed—leaving no permanent implant behind.
The key advantage: drug delivery without a permanent metallic scaffold. This is particularly valuable in arteries subject to repetitive motion and flexion, such as the superficial femoral artery and the popliteal artery. A meta-analysis of 27 randomized controlled trials examining DCB versus uncoated balloon angioplasty in femoropopliteal disease confirmed that DCBs significantly improve patency and reduce the need for repeat interventions.
A recent Nature Reviews Cardiology analysis (March 2026) noted that in long-segment diffuse atherosclerotic disease, DCBs and drug-eluting stents should be considered complementary rather than competing therapies, with DCB angioplasty offering a way to reduce the total number of stents implanted.
Drug-Eluting Stents: How They Work
A drug-eluting stent (DES) is a metal mesh scaffold coated with the same type of anti-proliferative medication. Once deployed in the artery, the stent physically holds the artery open while the drug coating slowly releases medication to prevent tissue overgrowth.
Drug-eluting stents have shown superiority over bare metal stents in the femoropopliteal segment. The Zilver PTX trial demonstrated durable clinical effectiveness of a paclitaxel-eluting stent through five years of follow-up, with sustained benefits in patency and freedom from re-intervention.
The primary advantage of DES over DCB is structural support: for arteries with significant recoil after balloon dilation, or for dissections (tears in the artery wall) that need scaffolding, a stent is necessary. The tradeoff is that the stent is permanent—it becomes a fixed part of your vascular anatomy.
DCB vs. DES vs. Traditional Stent: A Comparison
| Factor | Drug-Coated Balloon (DCB) | Drug-Eluting Stent (DES) | Bare Metal Stent |
|---|---|---|---|
| Permanent implant | No | Yes | Yes |
| Drug delivery | Yes (paclitaxel) | Yes (paclitaxel) | No |
| Restenosis prevention | Superior to POBA | Superior to bare metal | Moderate |
| Best for | Femoropopliteal lesions, in-stent restenosis, flexion zones | Lesions requiring scaffolding, significant recoil, long occlusions | Short focal lesions, iliac arteries |
| Repeat treatment | Easier (no prior stent to navigate) | More complex (in-stent intervention) | More complex |
| Fracture risk | N/A (no implant) | Low with newer designs | Moderate in flex zones |
| Evidence base | 27+ RCTs for femoropopliteal disease | Zilver PTX 5-year data | Extensive historical data |
How Your Vascular Specialist Decides
The choice between DCB and DES (or a combination) depends on several clinical factors. Lesion location matters: the superficial femoral artery and popliteal artery favor DCB because these vessels bend with every step, and stents in this location are subject to mechanical stress. The iliac arteries (in the pelvis) are more stable and often better served by stents. Lesion length and complexity are also important factors: short, focal narrowings may be well served by either approach, while long, diffuse disease may benefit from a “leave nothing behind” DCB strategy. Prior stent failure is another consideration: if you’ve already had a stent that re-narrowed (in-stent restenosis), DCB angioplasty is often the preferred re-intervention strategy.
This is not a decision patients need to make on their own. Your vascular specialist will assess your anatomy, disease pattern, and overall health to recommend the approach most likely to achieve durable results.
What This Means for PAD Patients in Maryland, DC, and Virginia
The availability of DCB and DES technology is not uniform across all vascular practices. At SACMD, our vascular team—led by Dr. Rodeen Rahbar—has access to the full spectrum of endovascular tools including drug-coated balloons, drug-eluting stents, atherectomy devices, and conventional angioplasty. This means treatment decisions are driven by your anatomy, not by what’s available on the shelf.
Our endovascular PAD treatment program serves patients at locations in Camp Springs, Waldorf, Silver Spring (Maryland), Washington DC, and Reston (Virginia). If you’ve been diagnosed with PAD and told you need a procedure, understanding these options can help you have a more productive conversation with your care team.
The Bottom Line
Drug-coated balloons and drug-eluting stents represent significant advances over plain balloon angioplasty and bare metal stents for PAD treatment. DCBs offer the advantage of drug delivery without a permanent implant—ideal for arteries in motion zones. DES provides structural support while delivering anti-restenotic medication for lesions that need scaffolding. The best approach is the one matched to your specific disease pattern, and that’s a decision your vascular specialist should make with you.
Frequently Asked Questions
Q: What is a drug-coated balloon for PAD?
A: A drug-coated balloon (DCB) is an angioplasty balloon coated with an anti-proliferative medication (typically paclitaxel) that is delivered directly to the artery wall during inflation, helping prevent the artery from re-narrowing without leaving a permanent implant behind.
Q: Is a drug-coated balloon better than a stent for PAD?
A: Both have shown superiority over plain balloon angioplasty. DCBs offer the advantage of no permanent metallic implant, which can be beneficial for arteries that bend and flex, like those behind the knee. The best choice depends on lesion characteristics and location.
Q: Does SACMD offer drug-coated balloon treatment?
A: Yes. Our vascular specialists use drug-coated balloons, drug-eluting stents, atherectomy, and other advanced endovascular techniques tailored to each patient’s anatomy and disease pattern.
Schedule a PAD evaluation: Call (240) 427-1630 or visit www.sacmd.com
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*Disclaimer: This article is for informational purposes only and does not constitute medical advice. Treatment decisions should be made in consultation with a qualified vascular specialist.*
Dr. Rahbar is an esteemed vascular surgeon at Surgical Associates, known for their exceptional contributions to the field of vascular surgery. As a board-certified vascular surgeon with over 20 years of invaluable experience, Dr. Rahbar is a respected authority in the medical community serving Camp Spring, Maryland and the whole community of Maryland. Their unwavering dedication to providing advanced care for patients with diseases of the arteries and veins has earned them a reputation for excellence. Dr. Rahbar’s work embodies a passion for precision and compassion, improving the lives of those they serve, one procedure at a time.