Smart materials strategy for vascular challenges targeting in-stent restenosis: a critical review

In-stent restenosis (ISR) presents a major challenge in vascular disease management, often leading to complications and repeated interventions. This review article explores the potential of existing smart materials strategies in addressing ISR, emphasizing advancements in materials science and biomedical engineering. We focus on innovative solutions such as bioactive coatings and responsive polymers that offer targeted responses to ISR-related internal and external triggers. These smart materials can dynamically adapt to the physiological conditions within blood vessels, responding in real time to various stimuli such as pH, oxidative stress and temperature. Moreover, we discuss preclinical progress and translational challenges associated with these materials as they move toward clinical applications. The review highlights the importance of controlled drug release and the need for materials that can degrade appropriately to minimize adverse effects. This work aims to identify critical research gaps and provide guidance to encourage interdisciplinary efforts to advance the development of smart stent technologies. Ultimately, the goal is to improve patient outcomes in vascular interventions by leveraging the capabilities of intelligent biomaterials to enhance ISR management and ensure better long-term efficacy and safety in-stent applications.