Multidimensional optimization of stent design for endothelial shear stress regulation: Geometric structuring, surface functionalization strategies to mitigate thrombosis and restenosis.

The occurrence of in-stent restenosis (ISR) is closely associated with abnormal distribution of endothelial shear stress (ESS), and optimizing stent design is crucial for improving patient prognosis. This review aims to comprehensively explore how stent design parameters-including geometric structure and surface functionalization-influence neointimal hyperplasia and thrombosis by modulating ESS, while also summarizing the latest technological strategies. A detailed discussion is provided on the design evolution from traditional coronary stents to for non-coronary arteries (cerebral aneurysm) micro-woven stents, analyzing the mechanisms by which factors such as streamlined profiles, reduced strut thickness, and optimized spacing improve hemodynamics. Furthermore, the article critically evaluates the advantages and current limitations of cutting-edge technologies such as computational fluid dynamics (CFD)-based optimization and endothelialization-promoting functional coatings. We conclude that multidimensional stent design optimization represents a future trend in regulating ESS and suppressing restenosis. Future research should focus on integrating personalized design with highly biocompatible materials to advance the clinical translation of next-generation vascular stents.