Specialty Balloons Versus Plain Old Balloon Angioplasty for Vessel Preparation Before Drug-Coated Balloon Therapy in Femoropopliteal Occlusive Disease.

Specialty balloons are a novel category of vessel preparation devices. This study compared their effectiveness and safety with plain old balloon angioplasty (POBA) in a real-world setting. A total of 1,574 patients who underwent drug-coated balloon (DCB) therapy for femoropopliteal occlusive disease at ten Chinese centers (2021-2023) were analyzed. Propensity score matching generated 434 balanced pairs. Compared with POBA, specialty balloons were associated with a lower stent implantation rate (19% vs 28%; p = 0.003), shorter median stent length (15 cm vs 19 cm; p = 0.017), and use of larger-diameter DCB (4.9 ± 0.5 mm vs 4.8 ± 0.6 mm; p < 0.001). Perioperative complications, ankle-brachial index, hospital stay, and 1-year outcomes-including clinically driven target lesion revascularization, major amputation, mortality, and composite endpoints-did not differ between groups. In the overall cohort, 26% required stenting. Independent predictors of stent implantation were chronic total occlusion, smoking, moderate-to-severe calcification, and greater lesion length, while specialty balloon use was protective. In conclusion, compared with POBA, specialty balloon demonstrated superior vessel preparation outcomes, manifesting as significantly reduced stent implantation requirements, shorter average stent length, and enabling the use of larger-diameter DCB.