DES design: Theoretical advantages and disadvantages of stent strut materials, design, thickness, and surface characteristics

Endovascular stents have historically been manufactured using metals and metal composites. While metallic implants in nonvascular locations have been biologically well tolerated, endovascular implants have been plagued by neointimal proliferation resulting in recurrent stenosis. Using prior in vitro and in vivo outcomes, novel research projects are under way to improve vascular implants. This review summarizes prior investigations of metal stents, analyzes new biopolymeric systems, and examines emerging technologies and manufacturing processes for surface modifications as well as bioabsorbable stent materials. Limitations of these new materials and manufacturing processes will be discussed along with potential new biologic applications.