Coronary stent designs have undergone significant transformations in geometry, materials, and drug elution coatings, contributing to the continuous improvement of stenting success over recent decades. However, the increasing use of percutaneous coronary intervention techniques on complex coronary artery disease anatomy continues to be a challenge and pushes the boundary to improve stent designs. Design optimisation techniques especially are a unique set of tools used to assess and balance competing design objectives, thus unlocking the capacity to maximise the performance of stents. This review provides a brief history of metallic and bioresorbable stent design evolution, before exploring the latest developments in performance metrics and design optimisation techniques in detail. This includes insights on different contemporary stent designs, mechanical and haemodynamic performance metrics, shape and topology representation, and optimisation along with the use of surrogates to deal with the underlying computationally expensive nature of the problem. Finally, an exploration of current key gaps and future possibilities is provided that includes hybrid optimisation of clinically relevant metrics, non-geometric variables such as material properties, and the possibility of personalised stenting devices.

翻译：冠状动脉支架设计在几何结构、材料和药物洗脱涂层方面经历了重大变革，推动了近几十年来支架置入成功率的持续提升。然而，经皮冠状动脉介入技术在复杂冠状动脉疾病解剖中的日益应用仍构成挑战，并不断推动支架设计改进的边界。设计优化技术作为一套独特工具，可用于评估和平衡相互竞争的设计目标，从而释放支架性能最大化的潜力。本综述首先简述金属及生物可吸收支架设计演进历程，随后详细探讨性能评估指标与设计优化技术的最新进展，涵盖当代多种支架设计、力学与血流动力学性能指标、形状与拓扑表征、优化方法，以及利用代理模型应对底层计算昂贵问题等内容。最后，本文探讨当前关键空白与未来可能性，包括临床相关指标的混合优化、材料属性等非几何变量优化，以及个性化支架装置的前景。