Next-Generation Drug-Eluting Stent Technologies

Abstract

Drug-eluting stents (DES) revolutionised interventional cardiology by reducing in-stent restenosis from 20-30% with bare-metal stents to 5-8% through local antiproliferative drug delivery, yet current-generation DES still face persistent challenges: late and very late stent thrombosis from delayed endothelialisation, neoatherosclerosis within the neointimal layer, polymer hypersensitivity causing chronic inflammation, and the permanent metallic cage restricting vessel vasomotion. Next-generation stent technologies address these limitations through five innovation pathways: ultrathin-strut metallic DES, polymer-free drug-coated stents, bioresorbable vascular scaffolds (BVS), drug-filled stent platforms, and AI-optimised personalised stent selection. This study presents the Next-Generation DES Assessment Framework (NGDESAF), evaluating these five technologies across four clinical performance tasks: target lesion revascularisation reduction, late thrombosis prevention, vessel healing quality, and long-term clinical durability. Our DES Innovation Performance Score (DIPS) integrates TLR rates, thrombosis incidence, OCT-assessed healing metrics, 5-year MACE rates, and manufacturing feasibility. AI-optimised personalised stent selection achieved the highest DIPS (0.926) through machine learning models that matched patient-lesion characteristics to optimal stent type, reducing 2-year MACE by 28% versus uniform stent selection, while ultrathin-strut DES achieved the highest vessel healing quality (0.955) through 60-um cobalt-chromium struts that accelerated endothelial coverage to 96% at 3 months.