From anti-proliferation to immunomodulation: engineering next-generation cardiovascular biomaterials

Cardiovascular devices such as stents, grafts, and bioprosthetic valves are vital treatments for advanced disease, yet long-term outcomes remain limited by chronic inflammation and poor tissue integration. Conventional drug-eluting devices rely on broad anti-proliferative agents that hinder healing and overlook the underlying mechanisms driving device failure. Growing evidence identifies dysregulated inflammation as a central cause of poor performance. Emerging selective immunomodulatory approaches aim to suppress pathological inflammation whilst promoting vascular regeneration. This review examines novel anti-inflammatory strategies relevant to cardiovascular devices and materials, including dual-drug systems and multimodal agents, and evaluates polymeric coatings, hydrogels, and nanoparticle platforms for targeted delivery. We also highlight translational challenges and propose pathways to integrate immunomodulatory design into clinically scalable cardiovascular devices.