Vascular-device suit concordance: a tri-ecological framework for eco-rebalancing

Panvascular intervention can restore lumen patency, exclude structural defects, or replace diseased valves, but procedural success does not reestablish ecological stability within the treated vessel. We propose eco-rebalancing as a tri-ecological framework in which durable device performance depends on coordinated recovery across three domains: the mechanical, cellular, and physicochemical-immune ecologies. Vascular-device suitcordance denotes the spatiotemporal match between a device's mechanical behavior, biological interface, and material persistence, and the healing trajectory of a specific vascular bed, lesion, and patient; we introduce the Suitcordance Score (Su-Score) as a conceptual metric of that match. This perspective reinterprets restenosis, thrombosis, fibrosis, calcification, and structural degeneration as signatures of incomplete eco-rebalancing, providing a translational basis for device design and patient-device matching.