Drug-eluting stents (DES) have revolutionized the treatment of coronary artery disease (CAD), significantly reducing the incidence of restenosis compared to bare-metal stents (BMS). Advances in stent technology, including improvements in polymer coatings, drug-elution profiles, and stent platforms, have enhanced long-term outcomes. This review focuses on the long-term efficacy and safety of DES, highlighting innovations in stent design and materials that aim to further reduce the risks of late restenosis, stent thrombosis, and the need for repeat revascularization. Challenges such as late stent thrombosis, dual antiplatelet therapy (DAPT) duration, and the emergence of bioresorbable stents are also discussed.