Advances in therapeutic strategies for atherosclerosis: from pharmacologics to stents and stent coatings

Atherosclerosis is a major contributor to cardiovascular disease globally, posing significant challenges for effective management. Conventional pharmacological therapies, particularly statins and lipid-lowering agents, remain pivotal due to their accessibility and long-term benefits, but are limited by suboptimal efficacy and side-effects. Nanomedicine presents promising targeted drug delivery systems that enhance treatment specificity while reducing toxicity, and has the potential for developing personalized therapy. In interventional cardiology, advances in stent technology from bare metal stents to drug-eluting stents and bioresorbable scaffolds have improved vascular healing, however complications such as delayed endothelialization, smooth muscle cell proliferation, and thrombosis persist. To further enhance stent performance and biocompatibility, innovative surface coatings have emerged, by precisely tailoring the chemistry, topography, and biofunctionalization to optimize healing, accelerate endothelialization, and minimize restenosis/thrombosis through diverse strategies. Despite progress, challenges pertaining to coating durability, manufacturing complexity, and limited long-term clinical evidence still continue. Future research should emphasize multifunctional coatings that synergistically enhance endothelial recovery and inhibit restenosis and thrombosis, with nanotechnology and biomimicry offering significant opportunities for next-generation stent development. This review explores a spectrum of anti-atherosclerotic approaches aimed at combating cardiovascular diseases, from pharmacological agents to stents, highlighting diverse material design principles and its biological performance, recent advances in nanoengineered stent coatings, and the overall clinical landscape.