Multidimensional Evolution of Surface Endothelialization Design Strategies: A Materials Biology Perspective

Abstract Surface design aimed at regulating the behavior of endothelial cells is currently a key research direction in cardiovascular interventional/implantable materials. This review focuses on three primary regulatory strategies in material biology: direct regulation, protein‐mediated regulation, and biological factor regulation. These strategies aim to promote the recovery of endothelial cell function by optimizing the interaction between materials and blood, cells, and tissues. Furthermore, these surfaces also exhibit diverse effects in vivo on different types of cells. It is precisely due to the complex factors and diverse effects in the pathological environment that these macro‐to‐micro regulation strategies exhibit opposing states on the material‐tissue efficacy interface. Therefore, this series of design ideas still faces challenges in practical applications, including time‐sequential functional changes after implantation, how to maintain protein activity in complex pathological environments, and how to accurately control the release of biological factors. The study concludes by emphasizing that the endothelialization surface modification of stent materials is moving towards multidimensionality, including exploring the synergistic effects of these strategies and how to achieve optimal therapeutic outcomes under various pathological conditions, in order to develop more effective and safer vascular stent materials and provide new solutions for the treatment of cardiovascular diseases.