Mechanical properties, drug eluting characteristics and in vivo performance of a genipin-crosslinked chitosan polymeric stent

Advances in Fabrication Technologies for the Development of Next-Generation Cardiovascular Stents

Coronary artery disease is the most prevalent cardiovascular disease, claiming millions of lives annually around the world. The current treatment includes surgically inserting a tubular construct, called a stent, inside arteries to restore blood flow. However, due to lack of patient-specific design, the commercial products cannot be used with different vessel anatomies. In this review, we have summarized the drawbacks in existing commercial metal stents which face problems of restenosis and inflammatory responses, owing to the development of neointimal hyperplasia. Further, we have highlighted the fabrication of stents using biodegradable polymers, which can circumvent most of the existing limitations. In this regard, we elaborated on the utilization of new fabrication methodologies based on additive manufacturing such as three-dimensional printing to design patient-specific stents. Finally, we have discussed the functionalization of these stent surfaces with suitable bioactive molecules which can prove to enhance their properties in preventing thrombosis and better healing of injured blood vessel lining.

Chitosan-based packaging films with an integrated antimicrobial peptide: Characterization, in vitro release and application to fresh pork preservation

Chitosan (CS) films were developed incorporating peptide HX-12C. The films were studied to determine their microstructures, physical properties, release properties of peptide HX-12C and functional properties. The results indicated that there may be hydrogen bonding interactions between CS and peptide HX-12C, thereby creating a homogeneous internal microstructure and lower crystallinity (10.8-12.8 %). Compared with CS film, CS-HX-12C films displayed lower light transmission, MC (20.8-19.9 %), WVP (8.82-8.59 × 10^-11·g·m^-1·s^-1·Pa^-1), OTR (0.015-0.037 cc/(m².day)) and higher WS (15.7-32.4 %) values. Moreover, controlled-release experiments showed that pH, ionic strength and temperature could all significantly affect the release of peptide HX-12C from the films. Finally, the increase of pH value and TVC and lipid oxidation of fresh pork were delayed due to the treatment with CS-2%HX-12C film. However, incorporating peptide HX-12C into CS films did not improve the mechanical properties of the films and their effects against protein oxidation. Our results suggest that the CS-based antimicrobial packaging films integrated with peptide HX-12C exhibit the potential for fresh pork preservation.

Fused Deposition Modeling and Characterization of Heat Shape Memory Poly(lactic) Acid-Based Porous Vascular Scaffold

Shape memory polymers have received widespread attention from researchers because of their low density, shape variety, responsiveness to the environment, and transparency. This study deals with heat-shape memory polymers (SMPs) based on polylactic acid (PLA) for designing and fabricating a novel porous vascular scaffold to treat vascular restenosis. The solid isotropic material penalization method (SIMP) was applied to optimize the vascular scaffolds. Based on the torsional torque loading of Hyperworks Optistruct and the boundary conditions, the topological optimization model of a vascular scaffold unit was established. Forward and reverse hybrid modeling technology was applied to complete the final stent structure's assembly. The glass transition temperature for the present SMPs is 42.15 °C. With the increase in temperature, the ultimate tensile strength of the SMPs is reduced from 29.5 MPa to 11.6 MPa. The maximum modulus at room temperature was around 34 MPa. Stress relaxation curves show that the material classification is a "thermoset" polymer. The superb mechanical properties, the transition temperature of the SMPs, and the recovery ratio made it a feasible candidate for a vascular scaffold. A circular tube based on the shape memory polymers was presented as an example for analyzing the recovery ratio in an unfolding state. A higher recovery ratio was obtained at a temperature of 65 °C with a tube thickness of 2 mm. Finally, the proposed porous vascular scaffold was successfully fabricated, assessed, and compared with the original and previously developed vascular scaffolds. The proposed scaffold structure regains its initial shape with a recovery ratio of 98% (recovery temperature of 47 °C) in 16 s. The tensile strength, Young's modulus, and bending strength of the proposed scaffold were 29.5 MPa, 695.4 MPa, and 6.02 MPa, respectively. The results showed that the proposed scaffold could be regarded as a potential candidate for a vascular implantation.

Biocomposite Materials Based on Poly(3-hydroxybutyrate) and Chitosan: A Review

One of the important directions in the development of modern medical devices is the search and creation of new materials, both synthetic and natural, which can be more effective in their properties than previously used materials. Traditional materials such as metals, ceramics, and synthetic polymers used in medicine have certain drawbacks, such as insufficient biocompatibility and the emergence of an immune response from the body. Natural biopolymers have found applications in various fields of biology and medicine because they demonstrate a wide range of biological activity, biodegradability, and accessibility. This review first described the properties of the two most promising biopolymers belonging to the classes of polyhydroxyalkanoates and polysaccharides-polyhydroxybutyrate and chitosan. However, homopolymers also have some disadvantages, overcome which becomes possible by creating polymer composites. The article presents the existing methods of creating a composite of two polymers: copolymerization, electrospinning, and different ways of mixing, with a description of the properties of the resulting compositions. The development of polymer composites is a promising field of material sciences, which allows, based on the combination of existing substances, to develop of materials with significantly improved properties or to modify of the properties of each of their constituent components.

Influence of Temperature and Polymer Concentration on the Nonlinear Response of Highly Acetylated Chitosan-Genipin Hydrogels

Strain hardening, i.e., the nonlinear elastic response of materials under load, is a physiological response of biological tissues to mechanical stimulation. It has recently been shown to play a central role in regulating cell fate. In this paper, we investigate the effect of temperature and polymer concentrations on the strain hardening of covalent hydrogels composed of pH-neutral soluble chitosans crosslinked with genipin. A series of highly acetylated chitosans with a fraction of acetylated units, FA, in the range of 0.4-0.6 was synthesized by the homogeneous re-N-acetylation of a partially acetylated chitosan or the heterogeneous deacetylation of chitin. A chitosan sample with an FA = 0.44 was used to prepare hydrogels with genipin as a crosslinker at a neutral pH. Time and frequency sweep experiments were then performed to obtain information on the gelling kinetics and mechanical response of the resulting hydrogels under small amplitude oscillatory shear. While the shear modulus depends on the chitosan concentration and is almost independent of the gel temperature, we show that the extent of hardening can be modulated when the gelling temperature is varied and is almost independent of the experimental conditions used to build the hydrogels (ex situ or in situ gelation). The overall effect is attributed to a subtle balance between the physical (weak) entanglements and covalent (strong) crosslinks that determine the mechanical response of highly acetylated chitosan hydrogels at large deformations.

Decellularized nerve extracellular matrix/chitosan crosslinked by genipin to prepare a moldable nerve repair material

Decellularized nerve extracellular matrix (NECM) composited with chitosan are moldable materials suitable for spinal cord repair. But the rapid biodegradation of the materials may interrupt neural tissue reconstruction in vivo. To improve the stability of the materials, the materials produced by NECM and chitosan hydrogels were crosslinked by genipine, glutaraldehyde or ultraviolet ray. Physicochemical property, degradation and biocompatibility of materials crosslinked by genipin, glutaraldehyde or ultraviolet ray were evaluated. The scaffold crosslinked by genipin possessed a porous structure, and the porosity ratio was 89.07 + 4.90%, the average diameter of pore was 85.32 + 5.34 μm. The crosslinked degree of the scaffold crosslinked by genipin and glutaraldehyde was 75.13 ± 4.87%, 71.25 ± 5.06% respectively; Uncrosslinked scaffold disintegrated when immerged in distilled water while the scaffold crosslinked by genipin and glutaraldehyde group retained their integrity. The scaffold crosslinked by genipin has better water absorption, water retention and anti-enzymatic hydrolysis ability than the other three groups. Cell cytotoxicity showed that the cytotoxicity of scaffold crosslinked by genipin was lower than that crosslinked by glutaraldehyde. The histocompatibility of scaffold crosslinked by genipin was also better than glutaraldehyde group. More cells grew well in the scaffold crosslinked by genipin when co-cultured with L929 cells. The decellularized nerve extracellular matrix/chitosan scaffold crosslinked by the genipin has good mechanical properties, micro structure and biocompatibility, which is an ideal scaffold for the spinal cord tissue engineering.

Chitosan/alginate/hyaluronic acid polyelectrolyte composite sponges crosslinked with genipin for wound dressing application

Wound dressing composed of polyelectrolyte complexes (PECs), based on chitosan/alginate/hyaluronic acid (CS/ALG/HYA) crosslinked by genipin, was prepared by freeze-dried molding. Genipin as excellent natural biological crosslinker was chose for high biocompatibility and improving mechanical properties of materials. The CS/ALG/HYA sponges (CAHSs) were characterized by FTIR, XRD, DSC and SEM. Porosity, swelling behavior and mechanical properties and in vitro degradation of CAHSs were investigated. The cytotoxicity assay was carried out on HUVEC cells in vitro and the result proves the good biocompatibility of CAHSs. Hemolysis tests indicated that the prepared CAHSs were non-hemolytic material (hemolysis ratio < 5%, no cytotoxicity). PT and aPPT coagulation tests demonstrated that CAHS2 and CAHS3 could both activate the extrinsic and intrinsic coagulation pathway and thus accelerated blood coagulation. Further, in a rat full-thickness wounds model, the CAHS2 sponge significantly facilitates wound closure compared to other groups. CAHSs exhibited adjustable physical, mechanical and biological properties. Thus, the chitosan-based polyelectrolyte composite sponges exhibit great potential as promising wound dressings.

Leveraging advances in chemistry to design biodegradable polymeric implants using chitosan and other biomaterials

The metamorphosis of biodegradable polymers in biomedical applications is an auspicious myriad of indagation. The utmost challenge in clinical conditions includes trauma, organs failure, soft and hard tissues, infection, cancer and inflammation, congenital disorders which are still not medicated efficiently. To overcome this bone of contention, proliferation in the concatenation of biodegradable materials for clinical applications has emerged as a silver bullet owing to eco-friendly, nontoxicity, exorbitant mechanical properties, cost efficiency, and degradability. Several bioimplants are designed and fabricated in a way to reabsorb or degrade inside the body after performing the specific function rather than eliminating the bioimplants. The objective of this comprehensive is to unfurl the anecdote of emerging biological polymers derived implants including silk, lignin, soy, collagen, gelatin, chitosan, alginate, starch, etc. by explicating the selection, fabrication, properties, and applications. Into the bargain, emphasis on the significant characteristics of current discernment and purview of nanotechnology integrated biopolymeric implants has also been expounded. This robust contrivance shed light on recent inclinations and evolution in tissue regeneration and targeting organs followed by precedency and fly in the ointment concerning biodegradable implants evolved by employing fringe benefits provided by 3D printing technology for building tissues or organs construct for implantation.

Interaction of different cell types with magnesium modified by plasma electrolytic oxidation

Magnesium (Mg) is a material widely used in industrial applications due to its low weight, ductility, and excellent mechanical properties. For non-permanent implants, Mg is particularly well-suited because of its biodegradability, while its degradation products are not harmful. However, Mg is chemically reactive, and cytotoxic hydrogen gas is released as part of the degradation. This adverse degradation can be tuned using plasma electrolytic oxidation (PEO). With PEO, a surface layer of MgO/Mg(OH)₂ is deposited on the surface of Mg in a controlled way. The electrolytes used during PEO influence the surface's chemistry and topography and thus expectedly the biological response of adhered cells. In this study, thin samples of commercial pure of Mg (c.p Mg) were modified by PEO guided by different electrolytes, and the biological activity was assessed on vascular cells, immune cells, and repair cells (adipose tissue-derived stromal cells, ASCs). Vascular cells were more vulnerable than ASCs for compounds released by surface-coated Mg. All surface coatings supported the proliferation of adhered ASC. Released compounds from surface-coated Mg delayed but did not block in vitro wound closure of fibroblasts monolayers. Preformed endothelial tubes were vulnerable for released compounds, while their supporting ASC was not. We conclude that PEO-based surface-coating of Mg supports adhesion and future delivery of therapeutic vascular repair cells such as ASC, but that the observed vulnerability of vascular cells for coated Mg components warrants investigations in vivo.

Chemical and physical chitosan hydrogels as prospective carriers for drug delivery: a review

This review summarizes and discusses recent research progress in chemical and physical chitosan hydrogels for drug delivery.

Blockade of adrenergic β-receptor activation through local delivery of propranolol from a 3D collagen/polyvinyl alcohol/hydroxyapatite scaffold promotes bone repair in vivo

Objectives

Activation of the sympathetic system and adrenergic β‐receptors following traumatic bone defects negatively impairs bone regeneration. Whether preventing β‐receptor activation could potentially improve bone defect repair is unknown. In this study, we investigated the effect of systematic administration and local delivery of propranolol through composite scaffolds on bone healing.

Materials and methods

Collagen/PVA/propranolol/hydroxyapatite（CPPH）composite scaffolds were fabricated with 3D printing technique and characterized by scanning electron microscope (SEM). Micro‐CT analysis and bone formation histology were performed to detect new bone formation. Osteogenic differentiation of bone marrow stromal cells (BMSCs) and osteoclastogenesis of bone marrow monocytes cultured with scaffolds extract were performed for further verification.

Results

Intraperitoneal injection of propranolol did not significantly improve bone repair, as indicated by micro‐CT analysis and bone formation histology. However, CPPH scaffolds exhibited sustained release of propranolol in vitro and significantly enhanced bone regeneration compared with vehicle collagen/PVA/hydroxyapatite (CPH) scaffolds in vivo. Moreover, in vitro experiments indicated the scaffolds containing propranolol promoted the osteogenic differentiation and migration of rat BMSCs and inhibited osteoclastogenesis by preventing β‐receptor activation.

Conclusions

This study demonstrates that local adrenergic β‐receptor blockade can effectively enhance the treatment of bone defects by stimulating osteogenic differentiation, inhibiting osteoclastogenesis and enhancing BMSCs migration.

A facile route to mechanically robust graphene oxide fibers

Excellent mechanical, electrical, and thermal properties of graphene have been achieved at the macroscale by assembling individual graphene or graphene oxide (GO) particles. Wet-spinning is an efficient and well-established process that can provide GO assemblies in fiber form. The coagulation bath in the wet-spinning process has rarely been considered for the design of mechanically robust GO fibers (GOFs). In this study, locating the amidation reaction in the coagulation bath yielded mechanically improved GOFs. The imides 1-ethyl-3-(3-dimethylaminopropyl)carbodiimide and N-hydroxysuccinimide were used to form covalent amide bonds between GO flakes and chitosan, thereby reinforcing the GOFs. Evidence and effects of the amidation reaction were systematically examined. The tensile strength and breaking strain of the GOFs improved by 41.6% and 75.2%, respectively, and the toughness almost doubled because of the optimized crosslinking reaction. Our work demonstrated that using a coagulation bath is a facile way to enhance the mechanical properties of GOFs.

Excellent mechanical, electrical, and thermal properties of graphene have been achieved at the macroscale by assembling individual graphene or graphene oxide (GO) particles.

Electrical stimulation of adipose-derived mesenchymal stem cells and endothelial cells co-cultured in a conductive scaffold for potential orthopaedic applications

Electrical stimulation (ES) has emerged as a useful tool to regulate cell behaviour, but the effect of ES on mesenchymal stem cell (MSC)/vasculogenic cell co-culture has not been investigated. Herein, human adipose-derived MSCs (AD-MSCs) and umbilical vein endothelial cells (HUVECs) were co-cultured in an electrically conductive polypyrrole/chitosan scaffold. Compared with AD-MSC monoculture, calcium deposition in the co-culture without and with ES (200 μA for 4 h/day) was 139% and 346% higher, respectively, after 7 days. As the application of ES to AD-MSC monoculture only increased calcium deposition by 56% compared with that without ES after 7 days, these results indicate that ES and co-culture with HUVECs have synergistic effects on AD-MSCs' osteogenic differentiation. ES application also significantly enhanced CD31 expression of HUVECs. In HUVEC monoculture, application of ES increased CD31 expression by 224%, whereas the corresponding increase in AD-MSC/HUVEC co-culture with ES application was 62%. The gene expression results indicate that ES enhanced the cellular functions in AD-MSC and HUVEC monoculture via autocrine bone morphogenetic protein-2 (BMP-2) and vascular endothelial growth factor (VEGF), respectively. In co-culture, crosstalk between AD-MSCs and HUVECs due to paracrine BMP-2 and VEGF enhanced the cellular functions compared with the respective monoculture. With application of ES to the AD-MSC/HUVEC co-culture, autocrine signalling was enhanced, resulting in further promotion of cellular functions. These findings illustrate that co-culturing AD-MSC/HUVEC in a conductive scaffold with ES offers potential benefits for bone defect therapy.

Effects of Genipin Concentration on Cross-Linked Chitosan Scaffolds for Bone Tissue Engineering: Structural Characterization and Evidence of Biocompatibility Features

Genipin (GN) is a natural molecule extracted from the fruit of Gardenia jasminoides Ellis according to modern microbiological processes. Genipin is considered as a favorable cross-linking agent due to its low cytotoxicity compared to widely used cross-linkers; it cross-links compounds with primary amine groups such as proteins, collagen, and chitosan. Chitosan is a biocompatible polymer that is currently studied in bone tissue engineering for its capacity to promote growth and mineral-rich matrix deposition by osteoblasts in culture. In this work, two genipin cross-linked chitosan scaffolds for bone repair and regeneration were prepared with different GN concentrations, and their chemical, physical, and biological properties were explored. Scanning electron microscopy and mechanical tests revealed that nonremarkable changes in morphology, porosity, and mechanical strength of scaffolds are induced by increasing the cross-linking degree. Also, the degradation rate was shown to decrease while increasing the cross-linking degree, with the high cross-linking density of the scaffold disabling the hydrolysis activity. Finally, basic biocompatibility was investigated in vitro, by evaluating proliferation of two human-derived cell lines, namely, the MG63 (human immortalized osteosarcoma) and the hMSCs (human mesenchymal stem cells), as suitable cell models for bone tissue engineering applications of biomaterials.

Hyaluronan-Itaconic Acid-Glutaraldehyde Films for Biomedical Applications: Preliminary Studies

New hyaluronic acid–itaconic acid films were synthesized as potential materials with biomedical applications. In this work, we explored the homogeneous cross-linking reactions of hyaluronic acid using glutaraldehyde in the presence of itaconic acid and triacetin as plasticizers.

Biomechanical properties were assessed in terms of stability by measuring swelling in aqueous environments, investigating wettability using contact angle tests, and evaluating bioadhesive performance. The ductility of the materials was evaluated through stress-strain measurements and the morphology was explored by scanning electron microscopy.

The results show that the incorporation of itaconic acid improved most of the desirable properties, increasing adhesiveness and reducing wettability and swelling. The use of triacetin enhanced the strength, bioadhesiveness, and ductility of the material.

Selective Tumor Cell Inhibition Effect of Ni-Ti Layered Double Hydroxides Thin Films Driven by the Reversed pH Gradients of Tumor Cells

Nitinol is widely fabricated as stents for the palliation treatment of many kinds of cancers. It is of great importance to develop nitinol stents with selective tumor cell inhibition effects. In this work, a series of pH sensitive films composed of Ni(OH)2 and Ni-Ti layered double hydroxide (Ni-Ti LDH) with different Ni/Ti ratios were prepared on the surface of nitinol via hydrothermal treatment. The films with specific Ni/Ti ratios would release a large amount of nickel ions under acidic environments but were relatively stable in neutral or weak alkaline medium. Cell viability tests showed that the films can effectively inhibit the growth of cancer cells but have little adverse effects to normal cells. Besides, extraordinarily high intracellular nickel content and reactive oxygen species (ROS) level were found in cancer cells, indicating the death of cancer cells may be induced by the excessive intake of nickel ions. Such selective cancer cell inhibition effect of the films is supposed to relate with the reversed pH gradients of tumor cells.

Genipin-structured peptide-polysaccharide nanoparticles with significantly improved resistance to harsh gastrointestinal environments and their potential for oral delivery of polyphenols

Genipin-cross-linked caseinophosphopeptide (CPP)-chitosan (CS) nanoparticles (smaller than 300 nm) showed significantly improved stability and adjustable release profile in the gastrointestinal (GI) tract. Optimal purification of the nanoparticles was established by centrifugation to terminate the cross-linking reaction, which was further confirmed and characterized by FT-IR. Results from transmission electron microscopy (TEM), dynamic light scattering (DLS), and electrophoretic mobility (ζ-potential) measurements revealed that genipin cross-linking significantly prevented the bursting of the CPP-CS nanoparticles in simulated stomach acid and their precipitation under neutral intestinal environment. Pepsin showed little impact on the nanoparticle colloid stability; however, trypsin induced their aggregations. Genipin cross-linking slowed the burst release of (-)-epigallocatechin-3-gallate (EGCG) from the nanoparticles. The EGCG-loaded nanoparticles showed strong cytotoxicity against cancer cells; meanwhile, the net nanoparticles demonstrated high biocompatibility. The findings in the present work provide fundamental information for the rational design of biopolymer nanoparticles as an effective delivery systems for polyphenols.

Similarities and differences in coatings for magnesium-based stents and orthopaedic implants

Magnesium (Mg)-based biodegradable materials are promising candidates for the new generation of implantable medical devices, particularly cardiovascular stents and orthopaedic implants. Mg-based cardiovascular stents represent the most innovative stent technology to date. However, these products still do not fully meet clinical requirements with regards to fast degradation rates, late restenosis, and thrombosis. Thus various surface coatings have been introduced to protect Mg-based stents from rapid corrosion and to improve biocompatibility. Similarly, different coatings have been used for orthopaedic implants, e.g., plates and pins for bone fracture fixation or as an interference screw for tendon-bone or ligament-bone insertion, to improve biocompatibility and corrosion resistance. Metal coatings, nanoporous inorganic coatings and permanent polymers have been proved to enhance corrosion resistance; however, inflammation and foreign body reactions have also been reported. By contrast, biodegradable polymers are more biocompatible in general and are favoured over permanent materials. Drugs are also loaded with biodegradable polymers to improve their performance. The key similarities and differences in coatings for Mg-based stents and orthopaedic implants are summarized.

In situ forming biodegradable electroactive hydrogels

In situ forming biodegradable electroactive hydrogels based on gelatin-graft-polyaniline enhanced the adhesion and proliferation of C2C12 myoblast cells.

Hydrogel membranes based on genipin-cross-linked chitosan blends for corneal epithelium tissue engineering

Novel polymeric hydrogel scaffolds for corneal epithelium cell culturing based on blends of chitosan with some other biopolymers such as hydroxypropylcellulose, collagen and elastin crosslinked with genipin, a natural substance, were prepared. Physicochemical and biomechanical properties of these materials were determined. The in vitro cell culture experiments with corneal epithelium cells have indicated that a membrane prepared from chitosan-collagen blend (Ch-Col) provided the regular stratified growth of the epithelium cells, good surface covering and increased number of the cell layers. Ch-Col membranes are therefore the most promising material among those studied. The performance of Ch-Col membranes is comparable with that of the amniotic membrane which is currently recommended for clinical applications.

Using genipin-crosslinked acellular porcine corneal stroma for cosmetic corneal lens implants

Acellular porcine corneal stroma (APCS) has been proven to maintain the matrix microenvironment and is therefore an ideal biomaterial for the repair and reconstruction of corneal stroma. This study aims to develop a method to prepare cosmetic corneal lens implants for leukoma using genipin-crosslinked APCS (Gc-APCS). The Gc-APCS was prepared from APCS immersed in 1.0% genipin aqueous solution (pH 5.5) for 4 h at 37 °C, followed by lyophilization at -10 °C. The color of the Gc-APCS gradually deepened to dark-blue. The degree of crosslinking was 45.7 ± 4.6%, measured by the decrease of basic and hydroxy amino acids. The porous structure and ultrastructure of collagenous lamellae were maintained, and the porosity and BET SSA were 72.7 ± 4.6% and 23.01 ± 3.45 m(2)/g, respectively. The Gc-APCS rehydrated to the physiological water content within 5 min and was highly resistant to collagenase digestion. There were no significant differences in the areal modulus and curvature variation between Gc-APCS and nature porcine cornea. The dark-blue pigments were stable to pH, light and implantation in vivo. Gc-APCS extracts had no inhibitory effects on the proliferation of keratocytes. Corneal neovascularization, graft degradation and corneal rejection were not observed within 6 months.

Microfabrication and nanotechnology in stent design

Intravascular stents were first introduced in the 1980s as an adjunct to primary angioplasty for management of early complications, including arterial dissection, or treatment of an inadequate technical outcome due to early elastic recoil of the atherosclerotic lesion. Despite the beneficial effects of stenting, persistent high rates of restenosis motivated the design of drug-eluting stents for delivery of agents to limit the proliferative and other inflammatory responses within the vascular wall that contribute to the development of a restenotic lesion. These strategies have yielded a significant reduction in the incidence of restenosis, but challenges remain, including incomplete repair of the endothelium at the site of vascular wall injury that may be associated with a late risk of thrombosis. A failure of vessel wall healing has been attributed primarily to the use of polymeric stent coatings, but the effects of the eluted drug and other material properties or design features of the stent cannot be excluded. Improvements in stent microfabrication, as well as the introduction of alternative materials may help to address those limitations that inhibit stent performance. This review describes the application of novel microfabrication processes and the evolution of new nanotechnologies that hold significant promise in eliminating existing shortcomings of current stent platforms.