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, structural 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植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结构中的广泛应用仍面临挑战，并促使支架设计不断突破优化边界。设计优化技术尤其是一套独特工具，用于评估和平衡相互竞争的设计目标，从而释放最大化支架性能的潜力。本综述首先简述金属支架和生物可吸收支架的设计演变史，随后详细探讨性能指标与设计优化技术的最新进展，包括不同当代支架设计的见解、结构及血流动力学性能指标、形状与拓扑表征方法，以及结合代理模型处理底层高计算成本问题的优化策略。最后，本文探讨当前关键空白与未来可能性，涵盖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可行性。