Author's summary
Percutaneous coronary intervention with drug-eluting stents has improved safety and efficacy, but recurrent events such as late stent thrombosis and restenosis underscore the need for alternative treatments. Drug-coated balloons (DCBs) offer promise by leaving nothing in the vessel wall, reducing the risk of stent-related issues, and promoting natural vascular healing. Although DCBs are currently recommended for in-stent restenosis and de novo small vessel disease, recent studies suggest that it is a promising alternative for other de novo coronary artery disease (CAD) settings. Advancements in DCB technology, imaging/physiology guidance, and pharmacotherapy are crucial for enhancing outcomes in de novo CAD management.