Bioinspired Coronary Stents: A Technological Perspective on Exosome-Mimetic Nanoengineering and Mini-Review of Existing Platforms

Abstract

Coronary artery disease (CAD) remains a leading cause of morbidity and mortality worldwide. Percutaneous coronary intervention (PCI) represents the standard treatment for CAD; however, significant challenges, such as in-stent restenosis, late thrombosis, and delayed endothelial healing, remain issues for long-term outcomes. The evolution of stents from bare metal and drug-eluting platforms to bioabsorbable and nanoengineered designs has reduced, but not eliminated, these complications. Meanwhile, exosome-mimetic nanovesicle (EMNV)-coated stents have emerged as a potential approach to address these limitations since EMNVs mimic the structure and biological function of natural exosomes. This mimetic ability enables targeted delivery of therapeutic agents such as microRNAs, growth factors, and anti-inflammatory molecules. Indeed, preclinical studies have previously demonstrated the ability of these stents to reduce neointimal hyperplasia, enhance endothelialization, and modulate inflammatory responses. Engineering strategies, including stimuli-responsive release triggered by pH or enzymatic activity, further improve the precision of therapeutic delivery. However, the transition to clinical application remains in its early stages, with key obstacles including the scalability and reproducibility of EMNV production, the stability of biologic coatings during application, and regulatory classification as combination products. Therefore, clinical translation will require standardized manufacturing standards, reliable potency testing, and long-term safety studies to overcome these challenges. Personalized medicine approaches using patient-derived exosomes and artificial intelligence (AI)-assisted stent design may provide additional opportunities to accelerate the transition. This review summarizes the evolution of coronary stent technology and discusses the potential and limitations of EMNV-based platforms. This article also outlines future directions that will guide the development of EMNV-based platforms as next-generation devices in interventional cardiology.