Bioactive Coatings for Cardiovascular Stents: Modulating Immune Response for Enhanced Performance

Abstract

Cardiovascular disorders remain a leading cause of death worldwide, and the use of contemporary stents is paving the way for a profound shift in the field of cardiology. In the surgical process postimplantation, the graft or stent and host-immune interaction play a significant role in the healing process, thus it is a major challenge in healthcare. To address these challenges, recent advancements have introduced bioactive coatings with specialized modifications in stents to enhance their interaction with surrounding environment. These next-generation coatings are emphasizing strategies that reduce immune responses, that achieve up to similar to 45% decrease in TNF-alpha expression and similar to 60% reduction in IL-1 beta release in vitro, as well as similar to 2.5-fold increase in M2/M1 macrophage ratio in animal models and promote vascular healing. In this review, we explore a range of coating materials, such as bioactive peptides, polymers, and composite systems, that have demonstrated the ability to elicit favorable biological responses while mitigating complications like inflammation, thrombosis, and restenosis. We explored the recent in vitro and in vivo research that shows the clinical potential of these coatings over times. Emerging innovations in this field highlight promising strategies for reducing inflammation and promoting endothelial healing in future cardiovascular stent designs.