Extracellular matrix and nitric oxide based functional coatings for vascular stents

Abstract

• Intravascular stents face perpetuating shortcomings, including thrombogenecity, poor re-endothelialization, and in-stent restenosis. • Extracellular matrix-based coatings improve stent performance by regulating vascular cell types and improving hemocompatibility. • Nitric oxide-based coatings regulate vascular homeostasis by promoting re-endothelialization and diminishing thrombogenecity. • Such bio-inspired coatings can also be extended to other medical devices, such as artificial blood vessels and blood-contacting materials. Cardiovascular diseases cause huge morbidity and mortality worldwide. Recently, vascular stents have been most frequently used to treat cardiovascular diseases thanks to their effectiveness at dilating blood vessels and maintaining the circulation of blood. However, stent expansion leads to endothelium injury posing thrombogenic and in-stent restenosis (ISR). In addition, the bioinertness and an acute lack of endothelium-like function on the surface of implanted vascular stents compromise their performance. Functional coatings of vascular stents to mimic endothelium- and extracellular matrix (ECM)-like functions could prevent thrombosis, inhibit the overgrowth of smooth muscle cells (SMCs), and promote the rapid restoration of native endothelium, hence effectively suppressing stent-related complications. Noticeably, ECM-based coatings including a multitude of bioactive molecular, such as growth factors, heparin, hyaluronic acid (HA)and so on, have been proven to play important effects on regulating ECs/SMCs behavior and improving blood compatibility of stents. Additionally, nitric oxide (NO), which is fundamental to the endothelium-mediated anti-thrombogenesity, anti-intimal hyperplasia and anti-inflammation, has been leveraged to improve vascular stent functions. Therefore, this review will highlight different strategies and biological role of ECM and NO based functional coatings on vascular stent. Lastly, some potential important factors for stents development are suggested as well.