功能化血管支架促进再内皮化的研究进展： 从“抑制增生”到“促进修复”

Research Progress on Functionalized Vascular Stents for Promoting Re-Endothelialization: From “Inhibiting Hyperplasia” to “Promoting Repair”

摘要: 经皮冠状动脉介入治疗(PCI)是治疗心血管疾病的重要手段，但支架植入后的再狭窄与晚期血栓形成仍是限制其长期疗效的主要瓶颈。尽管传统药物洗脱支架能有效抑制平滑肌细胞增殖，但其非选择性的抗增殖机制也常导致内皮细胞修复延迟，即“再内皮化延迟”。因此，当前血管支架的研发策略正经历从“抑制增生”向“促进修复”的转型。本文从PCI术后导致再内皮化延迟的病理机制着手，重点综述了两大类助力支架再内皮化的策略：一是利用多肽等生物活性分子联合聚合物构建复合涂层修饰支架表面，赋予其特异性识别和调控细胞行为的能力；二是通过表面微织构技术改善血液动力学，降低支架再狭窄风险。此外，本文还探讨了联合智能响应性递药系统促修复的可行性，包括基于活性氧、pH及酶微环境的内源性响应释放，以及磁场、超声等外源性刺激调控及可视化治疗策略，旨在为新一代功能化血管支架设计提供参考。

Abstract: Percutaneous coronary intervention (PCI) is a crucial therapeutic approach for cardiovascular diseases; however, in-stent restenosis and late stent thrombosis remain major bottlenecks limiting its long-term efficacy. Although traditional drug-eluting stents can effectively inhibit smooth muscle cell proliferation, their non-selective anti-proliferative mechanisms often delay endothelial cell repair, a phenomenon known as “delayed re-endothelialization”. Consequently, current research and development strategies for vascular stents are undergoing a paradigm shift from “inhibiting hyperplasia” to “promoting repair”. Starting from the pathological mechanisms underlying delayed re-endothelialization post-PCI, this review focuses on two primary strategies to promote stent re-endothelialization: first, constructing composite coatings using bioactive molecules (such as peptides) combined with polymers to modify stent surfaces, thereby endowing them with the ability to specifically recognize and regulate cellular behavior; second, utilizing surface micro-texturing techniques to improve hemodynamics and reduce the risk of in-stent restenosis. Furthermore, this paper explores the feasibility of joint intelligent responsive drug delivery systems for re-endothelialization. This includes endogenous stimulus-responsive release based on reactive oxygen species, pH, and enzymatic microenvironments, as well as exogenous stimulation regulation via magnetic fields and ultrasound, along with visualized therapeutic strategies. These insights aim to provide references for the design of next-generation functionalized vascular stents.