Cardiovascular disease is a leading cause of global mortality. Percutaneous coronary intervention, which involves the placement of stents to restore blood flow in narrowed arteries, is a widely used treatment. However, traditional stents, such as bare metal stents and drug-eluting stents, can lead to long-term complications such as restenosis, inflammation, and thrombosis. Biodegradable metallic vascular stents, with their superior mechanical properties, excellent biocompatibility, and gradual degradation in vivo, hold significant potential for the treatment of coronary artery disease. This review provides a comprehensive overview of the current research status and challenges. Firstly, it outlines the design principles and performance evaluation methods for biodegradable stents, which focus on mechanical properties, chemical characteristics, corrosion behavior, and biocompatibility. Furthermore, it summarizes the material features, degradation mechanisms, and metabolic behavior of three primary biodegradable metals—magnesium alloys, iron alloys, and zinc alloys—and discusses critical issues such as the degradation rate of different alloys and the development of zinc alloys. Finally, based on the current achievements and challenges of studies on biodegradable metal-based stents, this article proposes some optimization strategies and research prospects.