Peripheral artery disease (PAD), characterized by occlusion of peripheral arteries, causes ischemic complications and limb dysfunction. Endovascular stenting remains a primary therapy; however, developing biodegradable vascular stents with mechanical resilience and antithrombotic surfaces remains challenging. This study presents a 3D-printed biodegradable drug-eluting stent using silica–polycaprolactone nanocomposites and Janus surface nanoengineering. Sol–gel-derived silica creates stents with tuned radial strength and elliptical struts reducing flow disturbance. Janus nanoengineering through tantalum plasma immersion creates a nano-Ta-enriched luminal surface promoting endothelial cell growth, while the abluminal layer with sirolimus/poly-L-lactic acid suppresses smooth muscle cell proliferation. In vitro and in vivo tests show improved patency, reduced neointimal hyperplasia, and favorable tissue responses, representing a promising platform for vascular engineering.