Recent advances to accelerate re-endothelialization for vascular stents

Abstract

Cardiovascular diseases are considered as one of the serious diseases that leads to the death of millions of people all over the world. Stent implantation has been approved as an easy and promising way to treat cardiovascular diseases. However, in-stent restenosis and thrombosis remain serious problems after stent implantation. It was demonstrated in a large body of previously published literature that endothelium impairment represents a major factor for restenosis. This discovery became the driving force for many studies trying to achieve an optimized methodology for accelerated re-endothelialization to prevent restenosis. Thus, in this review, we summarize the different methodologies opted to achieve re-endothelialization, such as, but not limited to, manipulation of surface chemistry and surface topography.

Keywords: Stent; biomolecules; re-endothelialization; restenosis; surface modification.

Figure 1.

Schematic representation of the optimal surface for stent application. ECs: endothelial cells; SMCs: smooth muscle cells.

Figure 2.

The chemical structure of biomolecules used to promote the growth of endothelial cells: (a) heparin, (b) fucoidan, (c) chondroitin sulfate, (d) hyaluronic acid, and (e) gallic acid.

Scheme 1.

Schematic diagram for the production of NO from selenium catalyst.

Figure 3.

Schematic representation of (a) stainless steel stent covered with a layer of titanium and then another layer of polydopamine with the final surface covered with SeCA and (b) stainless steel stent covered with a layer of plasma-polymerized allylamine (PPAam) and then a final layer of SeDPA.

Scheme 2.

The mechanism of NO release: Cu⁺¹ (copper (I)), Cu⁺² (copper (II)), and RSNO (nitrosothiol).

Figure 4.

Schematic representation for the fabrication of ferritin-SLB system on the surface of glass.

Figure 5.

Schematic representation for the effect of surface morphology on proliferation of different types of cells.