Stent Design Research Articles

Preventive effect of surface charge on encrustation of biodegradable ureteral stents

Prevention of encrustation on the surface has always been the biggest challenge for urological implants. In the field of ureteral stent design, biodegradability has attracted much attention in recent years, because biodegradable ureteral stents not only avoid secondary intervention, but also prevent encrustation due to surface renewal by degradation process. Furthermore, researches have focus on some surface parameters to provide guidance for the development of stent materials, such as hydrophilicity or surface charge. In this work, we synthesized two types of poly(ester-carbonate)s, poly(L-lactide-co-5-amino-1,3-dioxan-2-one) (P(LA-co-AC)) containing amino, and poly (L-lactide-co-5-methyl-5-carboxyl-1,3-dioxan-2-one) (P(LA-co-MCC)) containing carboxyl. Blending P(LA-co-AC) and P(LA-co-MCC) with poly(L-lactide-co-Ɛ-caprolactone) (PLACL) respectively, two types of ureteral stent materials were prepared. Due to the influence of ions formed by the dissociation of amino and carboxyl, two types of materials show differences in surface charge analyses. We further developed a dynamic urinary extracorporeal circulation (DUEC) system to assess in vitro encrustation of materials with different surface charges. The results of this comparative study identified that the materials with strong negative surface charge were most favorable for use as ureteral stent, and provided a new approach to surmount the problems faced by urological surgery which complied with the future trend of biodegradable ureteral stent design.

Clinical Outcomes of Second- versus First-Generation Carotid Stents: A Systematic Review and Meta-Analysis.

Background: Single-cohort studies suggest that second-generation stents (SGS; “mesh stents”) may improve carotid artery stenting (CAS) outcomes by limiting peri- and postprocedural cerebral embolism. SGS differ in the stent frame construction, mesh material, and design, as well as in mesh-to-frame position (inside/outside). Objectives: To compare clinical outcomes of SGS in relation to first-generation stents (FGSs; single-layer) in CAS. Methods: We performed a systematic review and meta-analysis of clinical studies with FGSs and SGS (PRISMA methodology, 3302 records). Endpoints were 30-day death, stroke, myocardial infarction (DSM), and 12-month ipsilateral stroke (IS) and restenosis (ISR). A random-effect model was applied. Results: Data of 68,422 patients from 112 eligible studies (68.2% men, 44.9% symptomatic) were meta-analyzed. Thirty-day DSM was 1.30% vs. 4.11% (p < 0.01, data for SGS vs. FGS). Among SGS, both Casper/Roadsaver and CGuard reduced 30-day DSM (by 2.78 and 3.03 absolute percent, p = 0.02 and p < 0.001), whereas the Gore stent was neutral. SGSs significantly improved outcomes compared with closed-cell FGS (30-day stroke 0.6% vs. 2.32%, p = 0.014; DSM 1.3% vs. 3.15%, p < 0.01). At 12 months, in relation to FGS, Casper/Roadsaver reduced IS (−3.25%, p < 0.05) but increased ISR (+3.19%, p = 0.04), CGuard showed a reduction in both IS and ISR (−3.13%, −3.63%; p = 0.01, p < 0.01), whereas the Gore stent was neutral. Conclusions: Pooled SGS use was associated with improved short- and long-term clinical results of CAS. Individual SGS types, however, differed significantly in their outcomes, indicating a lack of a “mesh stent” class effect. Findings from this meta-analysis may provide clinically relevant information in anticipation of large-scale randomized trials.

Mathematical surface function-based design and 3D printing of airway stents

BackgroundThree-dimensional (3D) printing is a method applied to build a 3D object of any shape from a digital model, and it provides crucial advantages especially for transferring patient-specific designs to clinical settings. The main purpose of this study is to introduce the newly designed complex airway stent models that are created through mathematical functions and manufactured with 3D printing for implementation in real life.MethodsA mathematical modeling software (MathMod) was used to design five different airway stents. The highly porous structures with designated scales were fabricated by utilizing a stereolithography-based 3D printing technology. The fine details in the microstructure of 3D printed parts were observed by a scanning electron microscope (SEM). The mechanical properties of airway stents with various designs and porosity were compared by compression test.ResultsThe outputs of the mathematical modeling software were successfully converted into 3D printable files and airway stents with a porosity of more than 85% were 3D printed. SEM images revealed the layered topography of high-resolution 3D printed parts. Compression tests have shown that the mathematical function-based design offers the opportunity to adjust the mechanical strength of airway stents without changing the material or manufacturing method.ConclusionsA novel approach, which includes mathematical function-based design and 3D printing technology, is proposed in this study for the fabrication of airway stents as a promising tool for future treatments of central airway pathologies.

The "ins and outs" of the magnetic ureteral stent: A novel innovation in Endourology.

Ureteral stents play a major role in maintaining ureteral patency. Various innovations are advocated in the design and subsequent removal of traditional double-J ureteral stents, such as the magnetic-end double-J ureteral stent (MEDJUS). This stent facilitates outpatient removal using a magnetic stent removal device. This systematic review was conducted to analyze the published role, efficacy, and outcomes of MEDJUS. After PROSPERO registration (CRD42021235739), an electronic database search (PubMed, EMBASE, Cochrane Library, Scopus, and Web of Science) was performed on December 31, 2020. The search terms were as follows: "magnetic," "ureteric," "stent," "double-J," "urotech," and "Black-Star." Nine studies with a total of 685 patients were included in the systematic review. The total number of MEDJUS procedures used was 498 (73%) compared to the 187 (27%) traditional double-J stent method. Magnetic-end double-J ureteral stent extraction failure was reported in 8 cases (1.61%). Compared with traditional stents, MEDJUS showed a cost benefit in 5/5 studies. Better pain scores (during stent in situ) and (at stent removal) were observed in 2/3 and 3/4 of the studies, respectively. Magnetic-end double-J ureteral stent may serve as a viable alternative to traditional double-J stents, offering cost and pain benefits with similar rates of complications. Magnetic-end double-J ureteral stent also offers relative ease of extraction and a reduced need for inpatient removal. This ambulatory stent removal technique has forged its use in modern urological practice.

An investigation into patient-specific 3D printed titanium stents and the use of etching to overcome Selective Laser Melting design constraints

Due to limitations in available paediatric stents for treatment of aortic coarctation, adult stents are often used off-label resulting in less than optimal outcomes. The increasingly widespread use of CT and/or MR imaging for pre-surgical assessment, and the emergence of additive manufacturing processes such as 3D printing, could enable bespoke devices to be produced efficiently and cost-effectively. However, 3D printed metallic stents need to be self-supporting leading to limitations in their design.In this study, we investigate the use of etching to overcome these design constraints and improve stent surface finish. Furthermore, using a combination of experimental bench testing and finite element (FE) methods we investigate how etching influences stent performance. Then using an inverse finite element approach the material properties of the printed and etched stents were calibrated and compared. We show that without etching the titanium stents, the inverse FE approach underestimates the stiffness of the as-built stent (E = 33.89 GPa) when compared to an average of 76.84 GPa for the etched stent designs. Finally, using patient-specific finite element models the different stents’ performance were tested to assess patient outcomes and lumen gain and vessel stresses were found to be strongly influenced by the stent design and postprocessing.Within this study, etching is confirmed as a means to create open-cell stent designs whilst still conforming to additive manufacturing ‘rules’ and concomitantly improving stent surface finish. Additionally, the feasibility of using an in-vivo imaging-to-product development pipeline is demonstrated that enables patient-specific stents to be produced for varying anatomies to achieve optimum device performance.

Integrating particle tracking with computational fluid dynamics to assess haemodynamic perturbation by coronary artery stents.

AimsCoronary artery stents have profound effects on arterial function by altering fluid flow mass transport and wall shear stress. We developed a new integrated methodology to analyse the effects of stents on mass transport and shear stress to inform the design of haemodynamically-favourable stents.Methods and resultsStents were deployed in model vessels followed by tracking of fluorescent particles under flow. Parallel analyses involved high-resolution micro-computed tomography scanning followed by computational fluid dynamics simulations to assess wall shear stress distribution. Several stent designs were analysed to assess whether the workflow was robust for diverse strut geometries. Stents had striking effects on fluid flow streamlines, flow separation or funnelling, and the accumulation of particles at areas of complex geometry that were tightly coupled to stent shape. CFD analysis revealed that stents had a major influence on wall shear stress magnitude, direction and distribution and this was highly sensitive to geometry.ConclusionsIntegration of particle tracking with CFD allows assessment of fluid flow and shear stress in stented arteries in unprecedented detail. Deleterious flow perturbations, such as accumulation of particles at struts and non-physiological shear stress, were highly sensitive to individual stent geometry. Novel designs for stents should be tested for mass transport and shear stress which are important effectors of vascular health and repair.

Assessment of a Coated Mitomycin-Releasing Biodegradable Ureteral Stent as an Adjuvant Therapy in Upper Urothelial Carcinoma: A Comparative In Vitro Study

A major limitation of the treatment of low-grade upper tract urothelial carcinoma is the difficulty of intracavitary instillation of adjuvant therapy. Therefore, the aim of this in vitro study was to develop and to assess a new design of biodegradable ureteral stent coated with a silk fibroin matrix for the controlled release of mitomycin C as a chemotherapeutic drug. For this purpose, we assessed the coating of a biodegradable ureteral stent, BraidStent®, with silk fibroin and subsequently loaded the polymeric matrix with two formulations of mitomycin to evaluate its degradation rate, the concentration of mitomycin released, and changes in the pH and the weight of the stent. Our results confirm that the silk fibroin matrix is able to coat the biodegradable stent and release mitomycin for between 6 and 12 h in the urinary environment. There was a significant delay in the degradation rate of silk fibroin and mitomycin-coated stents compared to bare biodegradable stents, from 6–7 weeks to 13–14 weeks. The present study has shown the feasibility of using mitomycin C-loaded silk fibroin for the coating of biodegradable urinary stents. The addition of mitomycin C to the coating of silk fibroin biodegradable stents could be an attractive approach for intracavitary instillation in the upper urinary tract.

Advances in the development of biodegradable coronary stents: A translational perspective.

Implantation of cardiovascular stents is an important therapeutic method to treat coronary artery diseases. Bare-metal and drug-eluting stents show promising clinical outcomes, however, their permanent presence may create complications. In recent years, numerous preclinical and clinical trials have evaluated the properties of bioresorbable stents, including polymer and magnesium-based stents. Three-dimensional (3D) printed-shape-memory polymeric materials enable the self-deployment of stents and provide a novel approach for individualized treatment. Novel bioresorbable metallic stents such as iron- and zinc-based stents have also been investigated and refined. However, the development of novel bioresorbable stents accompanied by clinical translation remains time-consuming and challenging. This review comprehensively summarizes the development of bioresorbable stents based on their preclinical/clinical trials and highlights translational research as well as novel technologies for stents (e.g., bioresorbable electronic stents integrated with biosensors). These findings are expected to inspire the design of novel stents and optimization approaches to improve the efficacy of treatments for cardiovascular diseases.

Investigation of changing geometry parameters of nickel-titanium shape memory alloys wire stent in cardiovascular implants

The purpose of this investigation was to assess the effects of changing the Nitinol stent’s geometrical characteristics on the superelastic behavior of the stent using the finite element method. Four different geometrical parameters were considered and analyzed in sixteen stents. These geometrical parameters consisted of stent length, number of stent’s meanders, inside diameter of the stent and wire diameter. Results showed that decreasing either stent length or the number of stent meanders and increasing either the inside diameter of the stent or wire diameter generally result in more sensible superelastic behavior exposure. The effect of changing stent length is independent of the inside diameter and number of the stent’s meanders. Effects of changing inside diameter and number of stent's meanders were exactly dependent together. In addition, increasing wire diameter has a great effect on the maximum force. In conclusion, the results of this study may serve as guidelines for future stent design.

Recent Advances in Stent Technology: Do They Reduce Cardiovascular Events?

Drug-eluting stents are used in nearly all cases of percutaneous coronary revascularization and have been shown to be superior to balloon angioplasty or bare metal stents. The designs of these stents are continually evolving to maximize efficacy and safety. This review outlines the important components of a drug-eluting stent and highlights the changes in stent design that have led to the optimization of clinical outcomes. Most stents used in contemporary times are thin strut, durable polymer drug-eluting stents (DES) that elute either everolimus or zotarolimus. Newer DES designs incorporating bioresorbable polymers or ultrathin struts have shown encouraging safety and efficacy profiles. DES are essential for the management of patients with obstructive coronary artery disease and are used in most coronary interventions. Changes in stent designs over the past 30years reflect the ongoing need to address the limitations of earlier stents aimed to improve patient outcomes.

An in silico trials platform for the evaluation of stent design effect in post-implantation outcomes.

Bioresorbable Vascular Scaffolds (BVS), developed to allow drug deliver and mechanical support, followed by complete resorption, have revolutionized atherosclerosis treatment. InSilc is a Cloud platform for in silico clinical trials (ISCT) used in the design, development and evaluation pipeline of stents. The platform integrates beyond the state-of-the-art multi-disciplinary and multiscale models, which predict the scaffold's performance in the short/acute and medium/long term. In this study, a use case scenario of two Bioabsorbable Vascular Stents (BVSs) implanted in the same arterial anatomy is presented, allowing the whole InSilc in silico pipeline to be applied and predict how the different aspects of this intervention affect the success of stenting process.

Iliofemoral venous configurations from three-dimensional computed tomography venogram and their relevance to stent design

ObjectiveIliofemoral venous stenting has become the standard of care for patients presenting with quality-of-life impairing symptoms of chronic iliofemoral venous obstruction not responding to conservative measures. This has led to an increased use of venous stenting over the last several years. However, iliofemoral venous anatomy in patients requiring such intervention remains poorly elucidated. This study attempts to fill that gap. MethodsTwenty-two consecutive patients with intravascular ultrasound examination-confirmed chronic iliofemoral venous obstruction underwent three-dimensional reconstruction of their computed tomography venogram images. Relevant angles, tortuosity (tort index-ratio between centerline length, and straight line length), lengths, and diameters were computed and analyzed. We used t tests for comparisons between the right and left sides. A P value of .05 or less was considered significant. ResultsOf the angles calculated, the median of the angles between the horizontal and common iliac vein (CIV) was 66° on the right and 60° on the left (P < .01). The median inferior vena cava-CIV angle was 172° on the right and 165° on the left (P < .0001). The CIV-EIV angle was 159° on the right and 151° on the L (P = .01). Overall, the median tortuosity was 1.07 on the right and 1.12 on the left (P = .007). The median centerline length of the CIV was 42mm on the right and 60mm on the left (P < .0001). The median external iliac vein length was 73 mm on the right and 88 mm on the left (P < .0001). The overall median iliac vein length was 220 mm on the right and 237 mm on the left (P < .01). The median diameters of the inferior vena cava at the iliocaval confluence, 20, 40, and 60 mm cranial to the confluence, were 23, 20, 22, and 23 mm, respectively. ConclusionsOverall, the left side has steeper angles, greater tortuosity, and longer lengths than the right side. These disparities should be considered during femoroiliocaval stent construction.

Evolution of drug-eluting coronary stents: a back-and-forth journey from the bench to bedside.

Coronary stents have revolutionized the treatment of coronary artery disease. Compared with balloon angioplasty, bare-metal stents (BMSs) effectively prevented abrupt vessel closure but were limited by in-stent restenosis (ISR) due to smooth muscle cell proliferation and neointimal hyperplasia. The first-generation drug-eluting stent (DES), with its antiproliferative drug coating, offered substantial advantages over BMSs as it mitigated the risk of ISR. Nonetheless, they had several design limitations that increased the risk of late stent thrombosis. Significant advances in stent design, including thinner struts, enhanced polymers' formulation, and more potent antiproliferative agents, have led to the introduction of new-generation DES with a superior safety profile. Cardiologists have over 20 different DES types to choose from, each with its unique features and characteristics. This review highlights the evolution of stent design and summarizes the clinical data on the different stent types. We conclude by discussing the clinical implications of stent design in high-risk subsets of patients.

Development, characterisation, and modelling of processability of nitinol stents using laser powder bed fusion

Additive manufacturing (AM) of customised vascular or peripheral stents is of great potential for surgeons and patients, enabling the patients to have customised stents and achieving better outcomes from stenting procedures, with further advantages of having a resource efficient manufacturing process. In this study, the potential for AM of superelastic NiTi-based shape memory alloy (Nitinol) stents was investigated. Two stent designs, which are used for the treatment of complex peripheral artery stenosis in the lower limbs, were studied. Laser Powder Bed Fusion (LPBF) of two stent designs was studied to investigate the impact of the process parameters on the stent geometry, strut size, structural integrity and the phase transformations. The study demonstrated the successful manufacture of Nitinol stents via LPBF, with strut sizes in the range between 250 µm and ≈ 560 µm. The elastic modulus of the stents was between 56 and 73 GPa, which matches well with the elastic modulus of standard austenitic Nitinol. Chemical etching was used to reduce the strut diameter and to remove the partially melted particles. It was shown that the laser energy input has a vital role in controlling the Ni-evaporation and the subsequent changes in the transformation temperatures, as well as the morphology of the stents. The lower energy input results in a reduced Ni-evaporation, maintaining the austenite finish temperature at the expected range, in addition to generating a good build morphology.

Preparation of functional coating on magnesium alloy with hydrophilic polymers and bioactive peptides for improved corrosion resistance and biocompatibility

• A multifunctional coating was constructed on ZE21B alloy for biodegradable vascular stents. • MgF 2 layer and hydrophilic polymers in the functional coating could effectively protect ZE21B alloy from overfast degradation. • Anticoagulant ACH 11 peptides and ECs-selective REDV peptides in the functional coating could dramatically enhance the hemocompatibility and pro-endothelialization capacity of ZE21B alloy. • The functional coating systematically improved the corrosion resistance and biocompatibility of ZE21B alloy in vitro and in vivo . Biodegradable magnesium alloy stents (MAS) have great potential in the treatment of cardiovascular diseases. However, too fast degradation and the poor biocompatibility are still two key problems for the clinical utility of MAS. In the present work, a functional coating composed of hydrophilic polymers and bioactive peptides was constructed on magnesium alloy to improve its corrosion resistance and biocompatibility in vitro and in vivo . Mg-Zn-Y-Nd (ZE21B) alloy modified with the functional coating exhibited moderate surface hydrophilicity and enhanced corrosion resistance. The favourable hemocompatibility of ZE21B alloy with the functional coating was confirmed by the in vitro blood experiments. Moreover, the modified ZE21B alloy could selectively promote the adhesion, proliferation, and migration of endothelial cells (ECs), but suppress these behaviors of smooth muscle cells (SMCs). Furthermore, the modified ZE21B alloy wires could alleviate intimal hyperplasia, enhance corrosion resistance and re-endothelialization in vivo transplantation experiment. These results collectively demonstrated that the functional coating improved the corrosion resistance and biocompatibility of ZE21B alloy. This functional coating provides new insight into the design and development of novel biodegradable stents for biomedical engineering.

Two-Year Incidence of Permanent Pace-Maker Implantation Post Modified SAVR

Background and Aim of this Study: Patients presenting with aortic stenosis are offered surgical aortic valve (SAVR) or transcatheter aortic valve replacement (TAVR) as therapeutic options. However, both techniques are associated with postoperative conduction abnormalities necessitating PPMI. We evaluate in this paper the impact of a modified technique of SAVR- which aims to decrease the stress on the conduction system- on the incidence of PPMI for a 24 months period post-surgery. Methods: The perioperative course of 184 patients who underwent SAVR in Saint George Hospital University Medical center between January 2016 and June 2019 was assessed. The study compares the incidence of PPMI between two groups of patients. In group A, 92 patients underwent the classic SAVR and in-group B, and 92 patients underwent a modified SAVR. Results: The results revealed a significant decrease of PPMI from 12 to 2.2% during a two-year period follow up. A multi variate analysis showed that the modified technique was a strong predictor for PPMI post SAVR. In addition, this rate (2.2%) was lower than the ones reported after TAVR. Conclusion: This reproducible and reliable technique should be recommended whenever SAVR is performed. On the other hand, the low incidence observed may be adopted as a benchmark whenever TAVR is offered as a therapeutic option specially to intermediate and low risk patients. Moreover, this less traumatic technique should be retained whenever stent design modifications for TAVR are considered.

Update on thoracic endovascular aneurysm repair : New stent graft designs

In the last decade, new stent graft designs have evolved to tackle challenges in thoracic endovascular aortic repair. Aspecific focus on access vessel issues has led to the introduction of new low-profile endograft designs for most of the major products. The main objective of this article is to provide an overview of the available publications on new stent graft designs. Assessing recent publications on the major reiterations of thoracic endografts, benefits and drawbacks are discussed. Recent reiterations of major endografts for thoracic aortic endovascular repair have focused mainly on the development of low-profile devices. Through alterations on graft fabric as well as stent material and design, delivery systems were reduced in profile, thus, reducing access vessel complications or enabling an endovascular procedure altogether. Long-term data are already available for one endoprosthesis. Other refinements include insitu adaptation of the stent graft to the aortic arch curvature as well as the option of staged deployment to allow more precision and reduce manipulation close to supra-aortic branches. Especially in the case of low-profile endografts, preliminary and long-term results of access vessel complications are promising. In order to draw final conclusions as to how durable the results of aneurysm exclusion are, more long-term studies are warranted.

Computer‐Aided Analysis of the Corrosion Inhibition by Carbon‐Based Thin‐Film Coating on Vascular Bare Metal Stent Models

AbstractA simulation study of inhibiting the corrosion and corrosion‐based restenosis is presented by diamond‐like carbon (DLC) thin‐film coating on bare‐metallic intravascular stent models. The stents are designed and placed in a blood vessel model including a fatty‐plaque layer in the study. 316L‐stainless steel, CoCr‐alloy, and nitinol are assigned to the stent models considering stent manufacturing. Modeled stents are coated with a carbon‐based structure that mimics the DLC thin film. The electrochemical simulations are performed under the dynamic non‐Newtonian blood flow condition for a 1 year period. Electrolytic current densities, corrosion, and restenosis rates of the bare and coated stents are simulated using time‐dependent laminar flow and corrosion modules in multiphysics analysis software. Among the bare‐stent models, the highest corrosion rate is observed for 316L with 79 µm year−1 and the minimum corrosion rate is observed for nitinol with 9 µm year−1. Restenosis rates increase up to 36 µm year−1 due to the charged‐particle adhesion on the bare stent surfaces. However, DLC‐thin‐film coating reduces corrosion and in‐stent restenosis (ISR) rates down to 0.94 and 0.2 µm year−1 respectively. It can be concluded that surface passivation by thin‐film DLC coating may be considered a promising candidate for novel stent designs having lower corrosion‐based issues and ISR risks.

Development of a customisable 3D-printed intra-oral stent for head-and-neck radiotherapy.

Intra-oral stents (including mouth-pieces and bite blocks) can be used to displace adjacent non-involved oral tissue and reduce radiation side effects from radiotherapy treatments for head-and-neck cancer. In this study, a modular and customisable 3D printed intra-oral stent was designed, fabricated and evaluated, to utilise the advantages of the 3D printing process without the interruption of clinical workflow associated with printing time. The stent design used a central mouth-opening and tongue-depressing main piece, with optional cheek displacement pieces in three different sizes, plus an anchor point for moulding silicone to fit individual patients' teeth. A magnetic resonance imaging (MRI) study of one healthy participant demonstrated the tissue displacement effects of the stent, while providing a best-case indication of its comfort.

Design and Verification of a Novel Perfusion Bioreactor to Evaluate the Performance of a Self-Expanding Stent for Peripheral Artery Applications.

Endovascular stenting presents a promising approach to treat peripheral artery stenosis. However, a significant proportion of patients require secondary interventions due to complications such as in-stent restenosis and late stent thrombosis. Clinical failure of stents is not only attributed to patient factors but also on endothelial cell (EC) injury response, stent deployment techniques, and stent design. Three-dimensional in vitro bioreactor systems provide a valuable testbed for endovascular device assessment in a controlled environment replicating hemodynamic flow conditions found in vivo. To date, very few studies have verified the design of bioreactors based on applied flow conditions and their impact on wall shear stress, which plays a key role in the development of vascular pathologies. In this study, we develop a computationally informed bioreactor capable of capturing responses of human umbilical vein endothelial cells seeded on silicone tubes subjected to hemodynamic flow conditions and deployment of a self-expanding nitinol stents. Verification of bioreactor design through computational fluid dynamics analysis confirmed the application of pulsatile flow with minimum oscillations. EC responses based on morphology, nitric oxide (NO) release, metabolic activity, and cell count on day 1 and day 4 verified the presence of hemodynamic flow conditions. For the first time, it is also demonstrated that the designed bioreactor is capable of capturing EC responses to stent deployment beyond a 24-hour period with this testbed. A temporal investigation of EC responses to stent implantation from day 1 to day 4 showed significantly lower metabolic activity, EC proliferation, no significant changes to NO levels and EC's aligning locally to edges of stent struts, and random orientation in between the struts. These EC responses were indicative of stent-induced disturbances to local hemodynamics and sustained EC injury response contributing to neointimal growth and development of in-stent restenosis. This study presents a novel computationally informed 3D in vitro testbed to evaluate stent performance in presence of hemodynamic flow conditions found in native peripheral arteries and could help to bridge the gap between the current capabilities of 2D in vitro cell culture models and expensive pre-clinical in vivo models.