  Coronary stent designs have undergone significant transformations in
geometry, materials, and drug elution coatings, contributing to the continuous
improvement of stenting success over recent decades. However, the increasing
use of percutaneous coronary intervention techniques on complex coronary artery
disease anatomy continues to be a challenge and pushes the boundary to improve
stent designs. Design optimisation techniques especially are a unique set of
tools used to assess and balance competing design objectives, thus unlocking
the capacity to maximise the performance of stents. This review provides a
brief history of metallic and bioresorbable stent design evolution, before
exploring the latest developments in performance metrics and design
optimisation techniques in detail. This includes insights on different
contemporary stent designs, structural and haemodynamic performance metrics,
shape and topology representation, and optimisation along with the use of
surrogates to deal with the underlying computationally expensive nature of the
problem. Finally, an exploration of current key gaps and future possibilities
is provided that includes hybrid optimisation of clinically relevant metrics,
non-geometric variables such as material properties, and the possibility of
personalised stenting devices.
