Biomembrane-Camouflaged Stents: Promising Strategies for Advanced Coronary Interventions

Coronary stent implantation remains a cornerstone therapy for coronary artery disease, yet current stent technologies continue to face limitations including acute and late thrombosis, delayed re-endothelialization, chronic inflammation, and in-stent restenosis. These complications largely arise from the nonphysiological interface between the implanted device and the injured vascular microenvironment. Biomembrane-camouflaged stents have recently emerged as a promising strategy to engineer biologically instructive blood-contacting surfaces by integrating natural or artificial membrane systems onto stent platforms. In this review, we summarize recent advances in three major biomembrane-based strategies for coronary stent functionalization: cell membrane-camouflaged stents, liposome-camouflaged stents, and exosome-camouflaged stents. Biomimetic cell membrane coatings retain native bioactive signals that collectively facilitate immune evasion, thromboresistance, and vascular healing. Liposome-based coatings are tunable artificial biomembrane reservoirs for the localized delivery of anticoagulants, anti-inflammatories, nitric oxide releasers, antiproliferatives, and gene therapies. Exosome-functionalized stents further enable bioactive intercellular communication by transferring endogenous regulatory cargos that modulate endothelial regeneration, macrophage polarization, smooth muscle cell phenotype, oxidative stress, and neointimal remodeling. We further discuss fabrication approaches, biological mechanisms, preclinical evidence, translational barriers, and future design principles for these platforms. Although challenges remain in coating durability, sterilization, long-term storage, manufacturing reproducibility, and clinical validation, biomembrane-camouflaged stents represent a compelling direction for next-generation coronary intervention by transforming conventional stents from passive mechanical scaffolds into active regulators of vascular repair.