Drug-coated balloons (DCBs) have emerged as a promising alternative to traditional percutaneous coronary intervention, particularly for patients with high bleeding risk (HBR). Unlike permanent stents, DCBs deliver antiproliferative drugs offering the advantage of preserving vascular architecture while avoiding long-term scaffold implantation. The use of DCBs in treating in-stent restenosis (ISR) and small vessel disease has been well established, and recent data suggest its potential for reducing the duration of dual antiplatelet therapy (DAPT), thereby decreasing bleeding complications. Notably, several clinical trials demonstrate the safety and efficacy of DCBs in high-risk populations, showing low rates of major adverse cardiac events and target lesion revascularization. Although promising, further large-scale randomized trials are needed to validate the long-term benefits and optimal DAPT strategies for DCB use in coronary artery disease (CAD) patients, particularly those with HBR.