Endovascular therapy is a cornerstone in managing femoropopliteal lesions in patients with chronic limb-threatening ischaemia, but the optimal device choice remains debated. Findings presented at the European Society of Cardiology 2025 Congress investigated whether paclitaxel-based strategies—drug-coated balloons and drug-eluting stents—improve outcomes compared to non-paclitaxel strategies, such as plain old balloon angioplasty and bare metal stents. 

This multicentre, retrospective study included 1,470 patients treated between April 2010 and March 2023. Among these, 509 received paclitaxel-based therapy and 961 received non-paclitaxel-based therapy. Propensity score matching generated 201 well-balanced pairs for comparison. Before matching, the paclitaxel group had a higher one-year amputation-free survival rate (80.0% vs. 78.8%), but this difference disappeared after matching (Log-rank p = 0.662). 

These results suggest that paclitaxel-coated devices do not confer a significant clinical advantage in amputation-free survival among patients with chronic limb-threatening ischaemia undergoing femoropopliteal revascularization. The findings underscore the need to tailor device selection to patient-specific factors rather than default to paclitaxel-based strategies.