Three-dimensional printing as a cutting-edge, versatile and personalizable vascular stent manufacturing procedure:Toward tailor-made medical devices

Vascular stents (VS) have revolutionized the treatment of cardiovascular diseases, as evidenced by the fact that the implantation of VS in coronary artery disease (CAD) patients has become a routine, easily approachable surgical intervention for the treatment of stenosed blood vessels. Despite the evolution of VS throughout the years, more efficient approaches are still required to address the medical and scientific challenges, especially when it comes to peripheral artery disease (PAD). In this regard, three-dimensional (3D) printing is envisaged as a promising alternative to upgrade VS by optimizing the shape, dimensions and stent backbone (crucial for optimal mechanical properties), making them customizable for each patient and each stenosed lesion. Moreover, the combination of 3D printing with other methods could also upgrade the final device. This review focuses on the most recent studies using 3D printing techniques to produce VS, both by itself and in combination with other techniques. The final aim is to provide an overview of the possibilities and limitations of 3D printing in the manufacturing of VS. Furthermore, the current situation of CAD and PAD pathologies is also addressed, thus highlighting the main weaknesses of the already existing VS and identifying research gaps, possible market niches and future directions.This work was funded by the Basque Country Government/Eusko Jaurlaritza (Department of Education, University and Research, Consolidated Groups IT448- 22) . Sandra Ruiz-Alonso and Fouad Al -Hakim thank the Basque Country Government for the granted fellowships PRE_2021_2_0153 and PRE_2021_2_0181, respectively. Denis Scaini gratefully acknowledges support from IKERBASQUE, the Basque Foundation of Science