Advances and prospects in drug-like coatings on Mg alloy cardiovascular stents: A review

• This review overviews the latest advancements in functional coatings for Mg alloy vascular stents. • This review introduces the drug-like coating concept through the current research status and proposes the crucial issues confronting drug-like coatings for Mg alloy stents. • The future directions of drug-like coatings for Mg alloy stents are discussed in this review. Guided by the clinical concept of “intervention without implantation”, Mg alloys show promise as next-generation cardiovascular stent materials due to their complete degradability and excellent biocompatibility. Although existing drug-eluting coatings can delay Mg stent degradation and inhibit restenosis, the persistent drug release-induced delayed endothelial healing and increased thrombotic risks present a critical paradox that has severely hindered clinical translation. To address this challenge, researchers are focused on developing multifunctional coating systems that exhibit simultaneous anticoagulation and hyperplasia suppression, while promoting endothelial repair. This review systematically examines the following key research frontiers: natural bioactive molecular coatings, NO release coatings, and biofunctional molecular coatings, along with their various combinations, referred to collectively as “drug-like coatings”. The fabrication strategies, functional performance, and challenges associated with drug-like coatings are discussed, and suggestions and ideas are presented to guide future prioritization of development directions. This comprehensive analysis provides both a theoretical foundation and technological roadmaps for developing next-generation degradable Mg alloy stents with superior service performance and clinical safety.