There is increasing evidence that stent design influences angiographic restenosis and clinical outcomes. After nearly 15 years of clinical experience, there is now a plethora of stent designs available, and yet no single design incorporates all the characteristics of the ideal stent. The specific metallic composition of a stent limits the type of stent geometry possible, and the biocompatibility of the metal or surface coating may affect long-term stent healing. Studies have shown that stent geometry designed to optimize expansion and lower recoil is a prerequisite for favorable clinical outcomes. Strut thickness appears to be an important risk factor for restenosis, but changing one parameter, such as strut thickness, requires altering other design characteristics, thus altering the overall stent design. Future stent designs should combine the best features of conventional stent design with special modifications to facilitate multi-agent drug elution for a variety of applications.