Abstract
Over the past two decades, stents have revolutionized the treatment of cardiovascular diseases, particularly coronary artery and valvular heart disease. In this Review, we evaluate the clinical challenges associated with these diseases, as well as the manufacturing strategies for both coronary and heart valve stents, with a focus on the emerging role of 3D printing. Specifically, we assess the advantages and limitations of clinically available metallic and polymeric stents for coronary artery disease and provide an overview of the metallic and biodegradable polymeric stents developed to treat valvular heart disease. Furthermore, we explore the capabilities of key 3D-printing methods for stent fabrication, highlighting their strengths and drawbacks, and discuss the regulatory considerations that govern the clinical translation of 3D printing-based coronary and valvular stents. Taken together, 3D-printing technologies offer new opportunities to customize geometry, control stent degradation and improve stent implantation approaches for patients with complex anatomies. By merging innovations in material science, manufacturing strategies and bioengineering, 3D-printing technology has a major role in the next generation of personalized and multifunctional cardiovascular stents.
Key points
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The majority of clinically available coronary artery stents are predominantly manufactured using metals, but these metallic stents are associated with a high risk of restenosis and poor long-term biocompatibility.
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Newer biodegradable metallic stents aim to reduce the long-term risks of late thrombosis, chronic inflammation and impaired vessel remodelling while promoting natural artery healing.
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Emerging polymeric stents offer lower profiles and greater flexibility but require improvement in durability and mechanical properties.
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Both metallic and biodegradable polymeric stents have been explored for the treatment of valvular heart disease, each offering unique benefits, such as high radial strength and proven durability for metallic stents and biocompatibility and gradual resorption for biodegradable polymeric stents, and face distinct challenges, including limited flexibility and potential calcification in metallic stents and insufficient mechanical strength and complex degradation control in polymeric stents.
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3D-printing technology introduces precision and customization for stent fabrication, potentially surpassing traditional methods such as laser cutting.
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Acknowledgements
A.E., S.E.M. and M.Y.E. were supported by the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (grant agreement #852814 TAVI4Life). M.G. was supported by the Mäxi Foundation (grant recipients: S.P.H. and M.Y.E.).
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A.E. and F.B.C. researched data for the manuscript; A.E. and M.Y.E. wrote the manuscript; A.E., M.G., H.D. and M.Y.E. contributed to the discussion of content; and A.E., S.E.M., M.G., H.D., V.F., S.P.H. and M.Y.E. reviewed and edited the manuscript before submission.
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S.P.H. is a shareholder at LifeMatrix Technologies and Xeltis BV. M.Y.E. is a shareholder at LifeMatrix Technologies. The other authors declare no competing interests.
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Nature Reviews Cardiology thanks Atta Behfar, Giuseppe Biondi-Zoccai, Umberto Morbiducci and Manel Sabaté for their contribution to the peer review of this work.
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Ehterami, A., Motta, S.E., Generali, M. et al. Cardiovascular stent technologies for coronary and valvular heart disease: the potential of 3D printing for stent fabrication. Nat Rev Cardiol (2026). https://doi.org/10.1038/s41569-026-01275-x
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DOI: https://doi.org/10.1038/s41569-026-01275-x
