Original: https://doi.org/10.31083/rcm42781
Coronary artery disease (CAD) is still one of the main causes of illness and death worldwide. The standard treatment is percutaneous coronary intervention (PCI), where a stent is placed in the artery to keep it open. However, long-term problems remain, such as the artery narrowing again (restenosis), blood clots forming in the stent, and slow healing of the vessel lining.
Stent technology has improved over the years, moving from bare-metal stents to drug-eluting and then to bioabsorbable and nanoengineered designs. These advancements have helped reduce complications, but they have not completely solved them.
Recently, a new type of stent coated with exosome-mimetic nanovesicles (EMNVs) has gained attention. EMNVs imitate the structure and function of natural exosomes, allowing them to deliver therapeutic molecules directly where they are needed. These molecules can include microRNAs, growth factors, and anti-inflammatory agents. Animal studies have shown that EMNV-coated stents can reduce abnormal tissue growth inside the artery, speed up healing of the vessel’s lining, and reduce inflammation.
New engineering approaches can also make the stent release its therapeutic agents only when triggered by specific signals, such as changes in pH or certain enzymes, improving accuracy and safety.
Despite these advances, bringing EMNV-coated stents into clinical use is still challenging. Major obstacles include difficulty producing EMNVs at large scale, ensuring consistent quality, keeping the biological coating stable during the stent’s placement, and navigating regulatory approval since these stents are considered combination products.
To move forward, standardized production methods, reliable tests to measure biological activity, and long-term safety studies will be needed. Future opportunities include using exosomes derived from each individual patient and applying artificial-intelligence tools to improve stent design.
This review summarizes how stents have evolved and discusses both the promise and the limitations of EMNV-based technologies. It also highlights future directions for developing these platforms as the next generation of devices in interventional cardiology.