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Coronary stent designs have undergone significant transformations ingeometry, materials, and drug elution coatings, contributing to the continuousimprovement of stenting success over recent decades. However, the increasinguse of percutaneous coronary intervention techniques on complex coronary arterydisease anatomy continues to be a challenge and pushes the boundary to improvestent designs. Design optimisation techniques especially are a unique set oftools used to assess and balance competing design objectives, thus unlockingthe capacity to maximise the performance of stents. This review provides abrief history of metallic and bioresorbable stent design evolution, beforeexploring the latest developments in performance metrics and designoptimisation techniques in detail. This includes insights on differentcontemporary stent designs, structural and haemodynamic performance metrics,shape and topology representation, and optimisation along with the use ofsurrogates to deal with the underlying computationally expensive nature of theproblem. Finally, an exploration of current key gaps and future possibilitiesis provided that includes hybrid optimisation of clinically relevant metrics,non-geometric variables such as material properties, and the possibility ofpersonalised stenting devices.

The Road to the Ideal Stent: A Review of Stent Design Optimisation Methods, Findings, and Opportunities