Coronary atherosclerosis: From plaque evolution and stent-biomaterial interface to rehabilitation-induced vascular...

Coronary atherosclerosis is a chronic progressive disease driven by lipid metabolism disorders, inflammatory responses, and vascular structural remodeling.

This narrative review is based on a literature search of PubMed and Web of Science for articles published up to 2026, using keywords including "coronary atherosclerosis," "stent biomaterial," "vascular remodeling," and "cardiac rehabilitation."

This manuscript reviews the pathological evolution of the disease at the tissue and cellular level, covering endothelial dysfunction, extracellular matrix (ECM) remodeling, inflammatory cell infiltration, foam cell formation, and plaque calcification. This manuscript then focuses on the tissue dynamic response at the stent-vessel interface after implantation, analyzing acute injury, neointimal hyperplasia, and in-stent neoatherosclerosis (NA) and reviews bioengineering strategies for pro-healing stents. Furthermore, the role of cardiac rehabilitation (CR) in inducing vascular remodeling is explored, emphasizing the regulation of endothelial structure and function by blood flow shear stress, optimization of plaque components, and myocardial repair mechanisms.

By integrating pathological mechanisms, material interfaces, and rehabilitation interventions, this paper proposes a paradigm shift from "injury response" to "repair promotion." It looks forward to the application of tissue engineering, organoid models, and multi-omics technologies in precision intervention, providing a theoretical basis for personalized treatment and regenerative medicine strategies for coronary heart disease.