Talk:Drug-eluting stent/Archive 1

Question/comment
Well done! I find the article quite accessible on the whole. A few things: In the intro, it is written: "Inflammation in the artery wall causes injury". Is it inflammation which is causing injury or the other way 'round? Also, in the "History" section, the words "intraluminal" and "percutaneous" are used; I don't think their meaning would be obvious to the general reader. I stumbled when I got to them. Note: I'm not in the medical field. Figma 18:57, 26 July 2006 (UTC)


 * Thanks! I will clarify these when I get a chance. — Knowledge Seeker দ 06:56, 27 July 2006 (UTC)


 * I tried rewording. Tell me what you think; I appreciate the comments. — Knowledge Seeker দ 08:08, 27 July 2006 (UTC)


 * Nice! Much clearer to me.  Figma 22:10, 27 July 2006 (UTC)

Oh - something else: in the "Current Research" section, there is a sentence explaining that metal-based stents are problematic, and then the next sentence says something about newer magnesium-alloy stents. These seem contradictory, in a way, to me. Figma 22:14, 27 July 2006 (UTC)

List of approved devices with brief descriptions?
wondering how to handle companies' desire to have their particular products described (which is my view is not a bad thing and a decent article would run through them... i think) and still be encyclopedic. This article and this article and this article from a trade rag each provides a decent amount of info on approved devices to date. I think I like the idea of having a bulleted lists or a table describing devices that have been approved anywhere in the world (not investigational devices - the list is already pretty long and perhaps catalog-y.)  But it should be comprehensive (covering the main players and not giving any one company UNDUE weight) and it needs to be well sourced... thoughts?

This (adapted from the stuff above) is not bad and is what I have in mind...:
 * The Absorb (Abbott Vascular) naturally dissolving stent is designed from a platform of poly L-lactide (PLLA) then has a layer of poly-L poly-D polymer holding and eluting everolimus; it also has a pair of small platinum markers at the ends that remain after the stent dissolves to allow clinicians to locate where the stent was placed.(ref name=gogas2012>Gogas BD, Farooq V, Onuma Y, Serruys PW (2012). "The ABSORB bioresorbable vascular scaffold: an evolution or revolution in interventional cardiology?" Hellenic J Cardiol. 53(4):301-309</ref)

Something like that... Jytdog (talk) 05:52, 13 January 2016 (UTC)

Marketing
Come on, someone has to put some balance early in this article! I was fortunate/unfortunate enought to get stented just as the controversy was coming to a boil (Cypher in April 06 and Taxus in June 06). My cardio originally told me Plavix for a a few months, and so when the Rx expired after 6 months, I thought that was expected (It was really cuz I had missed my follow up appointment). When I went in several months later for my follow-up he almost shat himself (He knows I'm a PI lawyer). I got the feeling he wanted to start me on a drip and watch me for a few days, but he only lectured me and extended the Plavix for at least couple years.

People are relying on this article to make life-altering decisions. One of you doctors or academicians out there needs to incorporate some of the recent studies out there summarized at   I'm not qualified to assess what's what with those articles and fix this article .... but I will if someone else doesn't soon! --TjoeC 22:54, 10 October 2007 (UTC)


 * I read this comment from many moons ago - it got my attention and I did change the article to adress the concerns.
 * BeingObjective (talk) 14:50, 24 November 2023 (UTC)

Dissapointed to see that this article does not include much of the recent findings about delayed restenosis of drug eluting stents. Superiority over BMS is short-lived. From what I've read, long term mortality is higher in drug eluting stents (5-years). I would like more about this in this article. Right now it is a marketing article most likely written by the wizards at Boston Sci or J&J trying to promote their $12000 stents. Nice job if that is the purpose. Bad job for telling the whole story. Buyer BEWARE! — Preceding unsigned comment added by 71.213.125.161 (talk) 22:30, January 14, 2007


 * I'm going to have to agree. I've been re-editing the Angioplasty article which appeared to have been written by JNJ or Guidant marketing people.  Drug eluting stents appear to have problems with late thrombosis, but it is a trade off between that even and restenosis.  Orangemarlin 19:33, 5 March 2007 (UTC)


 * A very old comment - the article no longer reads as a promo - it is NPOV and follows GA guidance.
 * BeingObjective (talk) 14:51, 24 November 2023 (UTC)

Who started this page, the CEO of Boston Scientific? Experience what I have for the past 22 months and see if you feel the same way about DES's. I am one the the lucky ones who lived after stent restenosis and heart attack 5 months after having 2 Taxus Express2 implanted. It has been no cake walk. Out of work with no income and no disability. Not me, I'm only 56 years old. I'm going to work another 10 years, yeah right. Someone should wake up and tell the thruth for a change. Just like the mighty corporations in America, the almighty dollar rules. Keep it up America and we will go down just like the Romans. I proably won't be around to see it tho.

Input requested at Drug-eluting stent
If you just check the references you will see that no negative articles were used in production of this site. I believe the word is propaganda. Get all the facts before you put something like this out to the public. you could be lible too.

I hope you're not tired of me announcing my articles here, but I just wrote drug-eluting stent and I could definitely use some help. (I can't believe there wasn't already an article on it!) It's definitely one of the biggest articles I've tried writing from scratch (that and History of Earth), and I'm struggling a bit. I'd appreciate if any of you who have the time or desire could take a look. In addition to general comments and fixes, there are a few specific requests I have. First, please correct any inaccuracies or misleading statements. Second, how detailed should I make the "Uses" section? Should I describe the specific lesions that are stented? Specific trials? Third, help with the "tone" of the article, and properly balancing benefits and controversy would be appreciated. Fourth, what else can I do to expand or improve it? I can add technical details, but I'm not sure how beneficial they are in an encyclopedia article. I'd like to nominate it for peer review at some point, but it should probably be longer and I really would appreciate some medical feedback first. It would make a good topic for featured article, no? We've had plenty of featured articles on diseases and anatomic structures; how about an intervention/device for a change? — Knowledge Seeker দ 09:48, 23 July 2006 (UTC)


 * It is now balanced and NPOV. BeingObjective (talk) 14:52, 24 November 2023 (UTC)


 * Ok, first view:
 * categorize please
 * I fixed references to be small
 * what about external links?
 * Yes, you should improve Uses (maybe the most important section in the article). "Should I describe the specific lesions that are stented? Specific trials?" I think, yes. As the main part of the topic.
 * In my opinion, the leading should be a summary of the article, and a section called Structure or somewhat should be written about the stent itself.

Anyway great article, it was interesting to read. Congrat! After these, it can go to peer review. :) NCursework 10:39, 23 July 2006 (UTC)


 * PS:"I hope you're not tired of me announcing my articles here" - NEVER! :) NCursework 10:42, 23 July 2006 (UTC)


 * If you don't mind I move this discussion to the article's talk page. NCursework 18:25, 23 July 2006 (UTC)

Jargon
This article is very well written (kickass job, Knowledge Seeker); the only complaint I have is that, having no medical knowledge, I don't understand all of it. This isn't too much of a concern, as that's partly what wikilinking is for, but I think it's important to at least make the summary paragraph a little more accessible. ~ Booya Bazooka 21:08, 23 July 2006 (UTC)
 * "a drug blocking cell proliferation": What is a cell proliferation? I'm lost there.
 * "re-occluded by smooth muscle and clot (thrombus)": I suppose I just don't know what 'occluded' means.
 * "restenosis": This is clear to anyone who knows what stenosis is, but for those who don't — this paragraph really needs something akin to the phrase "narrowed blood vessels" in it somewhere.
 * "antiplatelet therapy": Another one that threw me off because I don't know anything about it. It's wikilinked, so it isn't necessary to explain what it is, but it would be nice to have a few words on why it is related to stenting.


 * You are right. I tried to keep the article as accessible as possible, but wasn't sure how to explain all the terms in the introduction itself without it getting too long. I think I'll err on that side, though, and significantly expand the introduction. — Knowledge Seeker দ 05:46, 24 July 2006 (UTC)


 * I tried incorporating the feedback you and NCurse provided. Please let me know what parts of the article remain inaccessible, as my goal here is to write for a popular encyclopedia, not a medical journal. NCurse, I tried splitting up the sections as you suggested. My rearrangements may have resulted in some out of place sentences or duplicated explanations, so for anyone reading this article, please let me know if I messed up (or if you see something obvious, feel free to change it yourself). I would like to especially hear from non-medical readers. — Knowledge Seeker দ 08:08, 25 July 2006 (UTC)
 * This has been corrected. BeingObjective (talk) 14:52, 24 November 2023 (UTC)

You did a great job! :) I think the article just needs external links + the improving of the uses section and it can go to peer review. NCursework 14:35, 26 July 2006 (UTC)


 * Thanks! I'll work on expanding the uses over the next couple days. I don't really have any plans to add external links—in general, I only add links to the official websites of my article subjects, or if there is a great resource I'm already aware of. I'm sure there are lots of websites discussing drug-eluting stents, but I really have no way of evaluating which one would be best, nor do I think that it's that helpful—I'd rather concentrating on improving the article. If there's some site you like, feel free to link to it. — Knowledge Seeker দ 16:32, 26 July 2006 (UTC)
 * Links added and reviewed.
 * BeingObjective (talk) 14:53, 24 November 2023 (UTC)

Comment and suggestion
As someone who works at a medical device company that works with drug eluting stents, I have to say this is a solid article. Very good job. I was very happy to see a section on controversy, because, on personal note, my dad (a doctor) had a drug eluting stent that didn't work properly (the stent wasn't coated properly) and it formed a clot that nearly killed him (ironic, since he had it put in after a previous heart attack). Needless to say I would like to expand that section, but I hesitate not to accidently insert my own POV. --Bobak 14:51, 26 July 2006 (UTC)
 * Okay, after a second read I have a suggestion (but for the above concern I would add it myself): there needs to be more on how the stents are coated and the problems that are still lingering (to the point that there are a myriad of companies trying to solve them). All the major players still have lingering problems with the coating process, including webbing, uneven coating and other problems inherent to how most are coated now (often a high-powered spray or dunking it in a vat): the spray is quite strong (realtively speaking, it's like a fire hose) and that results in some of the above issues; more issues form in the drying process, which is often baking (concerns about cracking sometimes eliminate more yield); the companies need to be careful with all of their processes because using too much energy or heat can alter the vital polymer; from a financial standpoint some of these companies are not having a high yield of successfully coated stents, and the spray is inefficient with the very expensive polymers.  I hope that gives the editors of this article some leads.  Good luck! --Bobak 15:04, 26 July 2006 (UTC)
 * Understood - changes to meet GA requirements. BeingObjective (talk) 14:54, 24 November 2023 (UTC)


 * Thanks for your comments! I am unaware of these details of the manufacturing process, and have not come across them in my research. If you have any references discussing these matters, I would be happy to take a look at them. — Knowledge Seeker দ 16:53, 26 July 2006 (UTC)

I'm also in the medical device testing arena, involved with benchtop testing of stents to evaluate their long-term durability. The issue of the stent-coatings and the rate at which they fall away from the product is one that is being looked at now. The issue though is that there is no consensus as to what rate of shedding is acceptable, and what level of particles represent a problem for the body to deal with (from blockages/absorbtion etc). The FDA is yet to give firm guidelines here. Dacsmsu 16:08, 30 November 2006 (UTC)


 * Reviewed and in this article. BeingObjective (talk) 14:54, 24 November 2023 (UTC)

Reference #3?
Anyone know what reference #3 in the article is supposed to be? I'm working on a "history of PCI" type article and could use the reference. Ksheka 10:04, 4 April 2007 (UTC)
 * Never mind. I found it in the history of edits. Ksheka 10:07, 4 April 2007 (UTC)
 * PCI discussed in context - links to a specific PCI article added. BeingObjective (talk) 14:55, 24 November 2023 (UTC)

Common misspellings
I have noticed the terms "drug-eluding stent" and "drug-alluding stent" have popped up. This is becoming such a common misspelling that you can find postings on the web from people who are unsure which is correct:
 * 

Should this article make reference to common misspellings, in order to
 * 1) help readers find the correct article
 * 2) assure readers that this is the correct article

Here's a funny blog entry:
 * 

It is getting to be a more widespread error.

It appears in publications of medical societies
 * 

It appears on the websites of companies selling the stents
 * 
 * 
 * 

I even see it in medical journal articles online!
 * 
 * 
 * 

It is a pretty common error from major news organizations
 * 
 * 
 * 

Hospitals and Health Centers make this error
 * 
 * 
 * 
 * 

Even WebMD and medscape get it wrong!
 * 
 * 
 * 
 * 

--SV Resolution(Talk) 18:01, 17 April 2007 (UTC)


 * Corrected. BeingObjective (talk) 14:56, 24 November 2023 (UTC)

Drug delivery mechanism
This article seems to imply that the drug is not (or at least not primarily) dissolved in the blood. It is absorbed directly by the venous tissue in contact with the stent matrix? Since only non-water-soluble compounds are currently being used, after water-soluble drugs like heparin were tried and rejected?

What is the eluting solvent? (Yes, I am a chemist) --SV Resolution(Talk) 18:11, 17 April 2007 (UTC)


 * Corrected. BeingObjective (talk) 14:56, 24 November 2023 (UTC)

compared with lipophilic (lipid soluble) drugs, water soluble drugs are transferred to the arterial wall tissue at a much much lower efficiency, so that even if a water soluble drug was effective at preventing tissue growth from the arterial wall, there would remain the challenge of getting sufficient concentration of the drug into the tissue to have a biological effect. Donsmokem 23:22, 5 September 2007 (UTC)

Partial merge with PCI
A lot of material on this page is general information about PCI and should be placed on that page. This page is about the stent itself - not the procedures for and applications of PCI. The introduction still looks very much like a slick marketing job by one of the device companies. Dlodge (talk) 21:54, 28 January 2008 (UTC)


 * I concur. We should move much of the text to a procedure page eg PCI and concentate on the stents themselves here, and mention the delivery systems maybe. Could have a section to summarise the approved stents, and the ones in clinical trials, and some preclinical ideas. & Perhaps we could move the controversy to a "DES or BMS controversy" page. Rod57 (talk) 02:22, 22 August 2008 (UTC)
 * Corrected. BeingObjective (talk) 14:56, 24 November 2023 (UTC)

Addition of new citation
ORIGINAL TEXT:Just for the record, I am preempting the reversions of my recent addition of the citation by saying that not only is this a valid scientific study for being cited, but that is one of the most accredited citations I've seen in a while, and is a welcome relief from the usual citations of userpages and online forums that I usually see. So there. If someone takes away the citation, I will dispute it, because unless the editor has a really good reason, the editor will have clearly demonstrated a personal COI or POV against stents. It's fine to prevent corporate vanity or use of the page as an advertisement, but you have to be careful to draw the line where there are extremely reputable facts for the inclusion of some positive factors of stents. NEW EDIT:As Dlodge pointed out, the link above requires cookies to be accessed. You can find it as the first result here, and it will load from the google link. However, I'd like to ask everyone here not to remove the link until I can get sokme admin input on whether to keep the citation, change it to the google result, or delete it. Thanks,Merechriolus (talk) 21:46, 13 March 2008 (UTC) NEW NEW EDIT: LOL NVMMerechriolus (talk) 21:57, 13 March 2008 (UTC)

Again, just preempting the citation being removed .Merechriolus (talk) 01:57, 13 March 2008 (UTC)
 * The link to the above citation needs fixing (the cookie doesn't work on others browsers). Dlodge (talk) 04:07, 13 March 2008 (UTC)
 * Okay, you're right...that's really stupid. Let me think of a way around that, one second.Merechriolus (talk) 21:38, 13 March 2008 (UTC)
 * Alright, the reason I linked to it in the first place is because google loads it automatically and I could read it. Here, it is the first result at the top of the page. I'll ask an admin about keeping the citation or not.Merechriolus (talk) 21:43, 13 March 2008 (UTC)
 * Had to preform an LOLFIX on the link. New link works.Merechriolus (talk) 21:57, 13 March 2008 (UTC)

Science yes, advertising no
The reference http://www.cypherusa.com/cypher-j2ee/cypherjsp/main_splash/mostproven.jsp added by Alyssa_hoffel seems not to meet the standard of impartiality for which we've been striving. I vote remove it. Donsmokem (talk) 02:26, 1 April 2008 (UTC)

No objections, so I am removing that link. Donsmokem (talk) 00:31, 3 April 2008 (UTC)


 * Corrected. BeingObjective (talk) 14:59, 24 November 2023 (UTC)

move Alternatives section ?
The Alternative section should not be in this article (because it equally well applies to other types of coronary stents). Any objections to moving it to coronary stent and referring to it from coronary artery disease ? Rod57 (talk) 00:05, 7 September 2008 (UTC)

Drug eluting balloon
Consider making an article about the drug-eluting balloon. It is relatively new compared to a DES, but there is no article wikipedia that I could find.

http://www.cambridgeconsultants.com/downloads/reports/DEB_report_09.pdf CrocodilesAreForWimps (talk) 21:40, 18 October 2011 (UTC)


 * Comment out of article scope. BeingObjective (talk) 15:00, 24 November 2023 (UTC)

new section
the following was added today:

==Marketing Controversies== The New york times quoted "In many hospitals, the cardiac service line generates 40 percent of the total hospital revenue, so there’s incredible pressure to do more procedures.When you put in a stent, everyone is happy — the hospital is making more money, the doctor is making more money — everybody is happier except the health care system as a whole, which is paying more money for no better results.”

After an investigation, India's Maharashtra Food and Drug Administration revealed that medical device companies sell cardiac drug eluting stents (DES) to patients at three times the cost of import price and cited an example to explain how the price reaches to whooping lakhs from a few thousands.The extra money that the distributors get are later used to bribe doctors so that the medicos only use their companies' devices in the future.

}

language violates NPOV ("whopping") and needs to be professsionalized. who was quoted in the NY Times? etc. Don't have time to do this now myself but this is not ready for publication. Jytdog (talk) 04:01, 13 May 2015 (UTC)


 * NPOV tone as of now. BeingObjective (talk) 15:01, 24 November 2023 (UTC)

Hello Jytdog, You have deleted my edit "Marketing Controversies". I read your explanation and corrected accordingly. Refer the following. May i proceed?

Marketing Controversies
In New york times, Dr. Brown said more than half of patients with stable coronary artery disease are now implanted with stents without even trying drug treatment.The reason, he believes, is financial.In many hospitals, the cardiac service line generates 40 percent of the total hospital revenue, so there’s incredible pressure to do more procedures.When you put in a stent, everyone is happy — the hospital is making more money, the doctor is making more money — everybody is happier except the health care system as a whole, which is paying more money for no better results.”

Earlier India's Maharashtra Food and Drug Administration revealed that medical device companies sell cardiac drug eluting stents (DES) to patients at three times the cost of import price and cited an example to explain how the price reaches to lakhs from a few thousands.The extra money that the distributors get are later used to bribe doctors so that the medicos only use their companies' devices in the future. — Preceding unsigned comment added by Meenakshi023 (talk • contribs) 05:42, 13 May 2015 (UTC)


 * thanks, i fixed this up more and added it. thanks for talking! Jytdog (talk) 13:08, 13 May 2015 (UTC)
 * Resolved. BeingObjective (talk) 15:01, 24 November 2023 (UTC)

Prolonged DAPT
... may cause about as much bleeding as it saves recurrent cardiac events 10.7326/M15-0083. Secondary source. JFW &#124; T@lk  15:00, 26 May 2015 (UTC)

Requested edits
I am an employee of Manifest, a marketing agency representing Abbott Vascular. I would like to request edits to this page as follows. If there are errors with citation format, please let me know and I will adjust. Thank you.

In the “Medical uses” section and a new paragraph at the end of the section:

One form of drug-eluting stent is a naturally dissolving stent, in which the actual stent structure dissolves after it is no longer needed. Abbott Vascular's Absorb, a naturally dissolving stent, has been approved in Europe and other markets around the world. It is in phase 3 development in the United States. DESolve bioresorbable scaffold (Elixir) is approved in Europe.

In the “Design” section, after the third paragraph (just above the subsection “Investigation and alternative drugs”), add the following paragraph:

Bioresorbable scaffolds, or naturally dissolving stents, are a form of stent, but are distinct in that they resorb over time. These can be designed from metals or other polymers. Two bioresorbable scaffolds have been approved for use in Europe and other markets but are not yet approved in the United States. The Absorb (Abbott Vascular) naturally dissolving stent is designed from a platform of poly L-lactide (PLLA) then has a layer of a mixed polymer along with the antiproliferative drug everolimus. It also has a pair of tiny platinum markers at the ends that remain after the stent dissolves to allow clinicians to locate where the stent was placed. The DESolve (Elixir) scaffold is also PLLA-based and has a polylactide-based coating containing novolimus.

In the “Design” section, in the subsection “Investigation and alternative drugs”, after the first paragraph (just after the sentence ending “…is the Genous bioengineered stent”) add the following paragraph:

Bioresorbable scaffolds based on dissolvable polymers are in clinical trials in the United States, but available in some markets globally (see previous section).

Recommend deleting the entire paragraph that begins “In place of the stainless steel (and now cobalt chrome) currently used in stents …”

At the end of the “History” section, add the following paragraph:

Drug-eluting stents have been associated with stent thrombosis later than 30 days after stent implantation owing to delayed healing related to the antiproliferative drug that is eluted. In order to avoid long-term effects of having a stent in place, fully resorbable scaffolds have been developed that resorb naturally over time so that no permanent stent is left in the artery. The naturally dissolving stents currently under development elute antiproliferative drugs for a period of time. One example is the Absorb naturally dissolving stent, which has been approved for use in Europe and other markets and is in phase 3 studies in the United States. These stents are different from drug-eluting stents that have resorbable polymer coatings, which leave behind a bare-metal stent after the coating has dissolved.

Please note: Text that had appeared at the end of the “History” section about approval of the Xience V everolimus eluting stent was deleted. Was there a reason for this?

In the “Society and culture” section, the first sentence of this section is an oversimplification of the current science. Suggest changing this section to the following:

There has been evidence that DES has been overused in patients who would not benefit. The appropriateness of PCI use depends on many factors. Although not appropriate for many patients, PCI may be appropriate for patients with stable coronary artery disease if they meet certain criteria, such as having any coronary stenosis greater than 50 percent or having angina symptoms that are unresponsive to medical therapy. In patients with acute coronary syndromes, PCI may be appropriate; however, guidelines and best practices are constantly evolving. In patients with severe blockages, such as ST-segment elevation myocardial infarction (STEMI), PCI can be critical to survival as it reduces deaths, myocardial infarctions and angina compared with oral medication.

Tom at Manifest (talk) 21:22, 16 November 2015 (UTC)
 * Hello.
 * Generally we prefer to have a citation after every sentence added. For some of these requests there is no associated citation, so by default, those are statements which are unlikely to be considered for inclusion. Would you be willing to associate citations with all of your statements?
 * Some of your statements talk about a company and particular products. Can you say why you think these products among all others should get a place in this article? This is the world's most consulted source of information on drug-eluting stents so we want to fairly weigh the article content to describe the field in proportion to importance of subtopics. What is the place of this company and product compared with its competitors? Which competing products and companies ought to also be listed in this article?  Blue Rasberry    (talk)  20:21, 17 November 2015 (UTC)
 * Article written following GA guidance - is seen as NPOV.
 * Dr. BeingObjective (talk) 15:02, 24 November 2023 (UTC)


 * Hello ,
 * Thank you very much for taking a look at our proposed edits and for your input. We would be happy to provide citations for each statement, and understand that this can help with data-checking. In an effort to be fair and balanced we already included the other product that we are aware is available in the marketplace, manufactured by Elixir Medical. We have no further information on whether that company is pursuing FDA approval in the U.S.
 * We believe that these products are important in that they represent the most recent advances related to overcoming past challenges among drug-eluting stents. They deserve to be discussed in this article because they have been approved and are being used in many markets around the world and may be available soon in the U.S. In its present form, we believe the drug-eluting stent page appears out of date, by not mentioning these. So our recommended changes are meant to clarify statements/update content that are in the article but based on the state of knowledge from several years ago. However, we kept the descriptions and additions brief and unpromotional in keeping with the spirit of Wikipedia.
 * We do not have market share data, but know of only the two products. The ABSORB was the first to receive European approval and has led in terms of research published and patient use. The DESolve product followed in approval in Europe. So it is not remarkable that there would be more detail on the ABSORB product when discussing bioresorbable stents.
 * Here is an article from 2014 giving some perspective and how these products are not just experimental and worthy of acknowledgement in an article on drug eluting stents. Thank you again for your input. Tom at Manifest (talk) 00:32, 4 December 2015 (UTC)


 * Note, I declined all the REs above since they have been repeated below.  Tom, one Request edit per batch is enough - we don't need all this clutter.  Thanks. Jytdog (talk) 22:54, 12 January 2016 (UTC)

Requested edits v2

 * Hello ,
 * We have updated the recommended edits to include citations after every sentence. I have re-pasted the recommended edits below. Please let me know your input on incorporating the recommended edits. Thank you for your help. Tom at Manifest (talk) 22:13, 12 January 2016 (UTC)

In the “Medical uses” section add a new paragraph at the end of the section:

One form of drug-eluting stent is a naturally dissolving stent, in which the actual stent structure dissolves after it is no longer needed. Abbott Vascular's Absorb, a naturally dissolving stent, has been approved in Europe and other markets around the world. It is in phase 3 development in the United States. DESolve bioresorbable scaffold (Elixir Medical Corporation) is approved in Europe.


 * I am declining this one.  We describe the devices in the Design section below, and the sources here are mostly press releases, which we avoid as much as we can. Jytdog (talk) 04:33, 13 January 2016 (UTC)

In the “Design” section, after the third paragraph (just above the subsection “Investigation and alternative drugs”), add the following paragraph:

Bioresorbable scaffolds, or naturally dissolving stents, are a form of stent, but are distinct in that they resorb over time. These can be designed from metals or other polymers. Two bioresorbable scaffolds have been approved for use in Europe and other markets but are not yet approved in the United States. The Absorb (Abbott Vascular) naturally dissolving stent is designed from a platform of poly L-lactide (PLLA) then has a layer of a mixed polymer along with the antiproliferative drug everolimus. It also has a pair of tiny platinum markers at the ends that remain after the stent dissolves to allow clinicians to locate where the stent was placed. The DESolve (Elixir Medical Corporation) scaffold is also PLLA-based and has a polylactide-based coating containing novolimus.


 * I used some of this but most is sourced to press releases and is not useable. Jytdog (talk) 05:44, 13 January 2016 (UTC)

In the “Design” section, in the subsection “Investigation and alternative drugs”, after the first paragraph (just after the sentence ending “…is the Genous bioengineered stent”) add the following paragraph:

Bioresorbable scaffolds based on dissolvable polymers are in clinical trials in the United States, but available in some markets globally (see previous section).
 * This whole section was outdated and I deleted it. Jytdog (talk) 05:44, 13 January 2016 (UTC)

Recommend deleting the entire paragraph that begins “In place of the stainless steel (and now cobalt chrome) currently used in stents …”
 * did this Jytdog (talk) 05:44, 13 January 2016 (UTC)

At the end of the “History” section, add the following paragraph:

Drug-eluting stents have been associated with stent thrombosis later than 30 days after stent implantation owing to delayed healing related to the antiproliferative drug that is eluted. In order to avoid long-term effects of having a stent in place, fully resorbable scaffolds have been developed that resorb naturally over time so that no permanent stent is left in the artery. The naturally dissolving stents currently under development elute antiproliferative drugs for a period of time. One example is the Absorb naturally dissolving stent, which has been approved for use in Europe and other markets and is in phase 3 studies in the United States.

These stents are different from drug-eluting stents that have resorbable polymer coatings, which leave behind a bare-metal stent after the coating has dissolved.
 * sources for the first part are too old.. not sure about where to take this at this point. Jytdog (talk) 05:44, 13 January 2016 (UTC)

Please note: Text that had appeared at the end of the “History” section about approval of the Xience V everolimus eluting stent was deleted. Was there a reason for this?
 * There is no edit request here. Please do not abuse these tags. Jytdog (talk) 05:44, 13 January 2016 (UTC)

In the “Society and culture” section, the first sentence of this section is an oversimplification of the current science. Suggest changing this section to the following:

There has been evidence that DES has been overused in patients who would not benefit. The appropriateness of PCI use depends on many factors. Although not appropriate for many patients, PCI may be appropriate for patients with stable coronary artery disease if they meet certain criteria, such as having any coronary stenosis greater than 50 percent or having angina symptoms that are unresponsive to medical therapy. In patients with acute coronary syndromes, PCI may be appropriate; however, guidelines and best practices are constantly evolving. . In patients with severe blockages, such as ST-segment elevation myocardial infarction (STEMI), PCI can be critical to survival as it reduces deaths, myocardial infarctions and angina compared with oral medication.


 * Need to think about this one. Jytdog (talk) 05:44, 13 January 2016 (UTC)


 * More than seven years have past since this comment - I note this whole article appeared to have be 'abandoned' - I made numerous tweaks and I do think it reads a little better. BeingObjective (talk) 22:24, 5 November 2023 (UTC)

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Wiki Education assignment: WikiMed Fall 2022
— Assignment last updated by Lihuashu1 (talk) 00:00, 29 October 2022 (UTC)

Addition of specific sections in regards to drug-eluting stent indications, contraindications, side effects, and efficacy
Lihuashu1 (talk) 00:11, 31 October 2022 (UTC)


 * Have tried to make the article read better - it is hard to avoid some medical terms - this article is about DES - but it is really hard to separate the PCI procedure from the design and use of DES product offerings.
 * I do not think this reads like an ad., in this form. (2023).
 * I note a lot of conflict in citing studies - I am still not happy this is a good article - debating the results of so many old studies and citing fearful statistics is really not the place of such an article. IMHO.
 * Cheers Dr. BeingObjective (talk) 14:08, 5 November 2023 (UTC)

Tags and Ad claim - REMOVAL
I reworked most of the introduction - I think it reads better. I do not in 2023 read this as an ad. This tag was added more than 8 years ago - the article has been heavily modified since then. BeingObjective (talk) 15:36, 22 October 2023 (UTC)

Potential GA article
Thank all the editors who contributed to the article, especially for the recent work by User:BeingObjective on the article!

I reviewed it and my impression is that the article is almost ready for GA, but the information should be rearranged and referenced.

General considerations on style
I recommend to read Manual of Style/Medicine-related articles and all linked articles from that article that are related to medicine in Wikipedia.

In this article, of particular interest is the section Drugs, treatments, and devices There were minor issues when some sentences did not have a space between them, or had two spaces, I fixed those.

Lead section
The lead section should be rewritten according to Manual of Style/Lead section. Its length should be commensurate with that of the article, but is normally no more than four paragraphs. However, I found that medical articles with GA or FA status having good lead section are among the first that I found: Writing better articles.

For this kind of article, I recommend a lead section of 4 paragraphs. See other featured articles and good articles on similar medical devices and implants to gain insight. You can try to search at WikiProject Medicine, although I did not find from the first glance. However, I can recommend you to review the articles like Digital media use and mental health, ALS, Magnetic resonance imaging, Animal testing.

Correct article structure
Based on information from Wikipedia rules, I propose the following table of contents (see below). These should be higher-level sections. Other sections not listed here should be lower-level sections inside those mentioned. Not all the sections listed below are needed, you may omit some if no information is enough to fill them. While editing, you still can create all sections and put one or two-sentence placeholder in each section. I suggest the following sections:
 * Uses (along with evaluations of efficacy)
 * Contraindications
 * Risks/Complications
 * Technique (on how to install the device) and Preparation (for the procedure by the patient)
 * Recovery or Rehabilitation
 * Adverse effects or Side effects
 * Interactions (with other devices, and, if applicable, with other drugs or medical procedures)
 * Interaction with bodily tissues
 * Pharmacology (of the most drugs usually delivered by the device, if can be described combinatively)
 * Device lifetime (if dissolved, describe mechanisms of dissolution and further excretion, how are various parts metabolized and excreted as molecules or not excreted, if so, where accumulated)
 * Physics and physical properties of the device (if there is enough information for a separat section; here can be more information on particular physcial properties of the device, like various kinds of meshes, etc...)
 * Manufacturing
 * History
 * Society and culture
 * Legal status
 * Recreational use (if any?)
 * Economics (such as worldwide annual volumes, cost of one device for manufacturing, end-user price of device, whole-service price (device + installation))
 * Brand names
 * Ethical and medicolegal issues any ethical issues that are specific to this field
 * Media portrayals (please try avoid conclusions and synthesis, rely on secondary sources)
 * Notable cases (mentioning by celebrities, in top-tier news (unless there is a separate media portrays section), in fictional literature, in songs and poems, if any)
 * Research: Include only if addressed by significant secondary medical sources, avoid useless statements like "More research is needed"; wikipedia is not a directory of clinical trials or researchers, primary sources should not be used even in the research section
 * Special populations (if any)
 * Veterinary use or other animals

Target audience
The target audience seems to be for a general reader and the text it looks good for my eyes. I only noticed one minor issue. There is a section “Long term outcomes” but it is not specified which term is considered long. It should be specified in the number of years at the beginning of the section with a reliable source like a manual of medicine.

Discussion as a stent as one thing.
I think it inaccurate to talk of a DES as a thing on its own - this article was expanded to include PCI - I am not aware of how one could thoughtfully discuss a DES without PCI/Integrated system - much of the content matter already talked to PCI - it is called DES - and that is why I did ONLY focus only on DES design topics - the title of this current article really is rather different than just DES. One thought is to combine articles on PCI/DES - but the scope has to stop at some point. BeingObjective (talk) 21:13, 19 November 2023 (UTC)


 * You can propose to split the article via a request as explained in Proposed article splits Maxim Masiutin (talk) 12:29, 21 November 2023 (UTC)

Ignoring some detailed discussion on PCI.
It is really impossible to discuss DES without some detailed mention of PCI - one cannot place a modern stent system in any other manner - they come as an integrated system for PCI delivery. Many articles create an impression they are free standing entities. "In a modern context, coronary artery stenting is inherently tied to Percutaneous coronary intervention (PCI) procedures. PCI is a minimally invasive procedure performed via a catheter (not by open-chest surgery)". BeingObjective (talk) 14:39, 22 November 2023 (UTC)

On reflection - this is a very detailed article
On reflection and reading GA guidance, I do think this article is now far too detailed.

While many of the sections seem appropriate for a well written encyclopedia article, the article does do a lot of 'deep dives' into some areas - it is likely a lot easier to remove content than to create it and I think this article needs to be debulked per GA guidelines.

This article is not that unusual for a multi-editor medical article on this platform - but I am not really sure of the target audience anymore.

Dr. BeingObjective (talk) 16:06, 23 November 2023 (UTC)

Consistent citation formatting (Vanc. style)
can you please make consistent citation formatting (Vanc. style) for Drug-eluting stent? Thank you!

We will then use https://citation-template-filling.toolforge.org/cgi-bin/index.cgi to generate links (with the "Add ref tag" checkbox checked) - Maxim Masiutin (talk) 22:11, 23 November 2023 (UTC)


 * I did add a little language as DES products do get used in PAD and such - this article always focused on CAD - and I think one could argue it is the major use - it really is any narrowed arterial vessel - PAD, carotids in the neck - renal blood supply - even arterial rips like artery dissections - no one ever actually mentioned this in the article we inherited - I have far less knowledge of these usage situations - I did see an intervention performed in the carotid artery - back in 2015 - I am not sure what stent was used - BeingObjective (talk) 22:18, 23 November 2023 (UTC)
 * Ok, thank you! I have resolved all the cases of citation overkill in the meanwhile and still working on checking whether a particular source is technically OK for wikipedia. Maxim Masiutin (talk) 22:32, 23 November 2023 (UTC)
 * Sounds good - there are a few citations that likely are at issue - I looked to two major manufacturers of DES/PCI Products - Medtronic and Boston Scientific - they are important as their products are what is actually at the center of many of these numerous related articles.
 * I think taking promotional claims would not be a great thing - and personally have not done this - in the past other editors did so.
 * If you look at this talk section - this was a lot of original chatter about the article.
 * But the reality is 4 or 5 companies produce stents - so one cannot ignore their info.
 * BeingObjective (talk) 23:30, 23 November 2023 (UTC)
 * About the source from manufacturers: if the data is about devices, like device parameters, size, material than OK. If they are about health claims, i.e. how these devices affect organism, than it is not OK unless these claims are approved by FDA. Can you please give specific examples? Maxim Masiutin (talk) 00:29, 24 November 2023 (UTC)
 * By the way, are you aware of the page Drug-eluting implant? Maxim Masiutin (talk) 00:31, 24 November 2023 (UTC)
 * Can you please specify which information exactly in the article you wish to back up by the information from device manufacturers? Maxim Masiutin (talk) 00:31, 24 November 2023 (UTC)
 * I think that the regulatory information and the information about approved devices by FDA are reliable sources, although I may be wrong. Should I ask in the Teahouse? When I had questions, I asked in Teahouse and people replied very fast.
 * I have a feeling that the sources like the following are OK:
 * https://www.fda.gov/medical-devices/recently-approved-devices/slender-sirolimus-eluting-coronary-stent-integrated-delivery-system-and-direct-sirolimus-eluting
 * https://www.fda.gov/medical-devices/recently-approved-devices/resolute-onyx-zotarolimus-eluting-coronary-stent-system-onyx-frontier-zotarolimus-eluting-coronary
 * https://www.fda.gov/combination-products/jurisdictional-updates/jurisdictional-update-drug-eluting-cardiovascular-stents
 * Maxim Masiutin (talk) 00:38, 24 November 2023 (UTC)
 * On FDA matters - it is hard to challenge - but likely someone will - BeingObjective (talk) 00:42, 24 November 2023 (UTC)

Title Change Proposal
@Maxim Masiutin - I seriously wonder if this article should have a title change - I propose:

Drug-eluting stents and Interventional Cardiology

I think this is what the article discusses as written. I am not sure it would need any major changes in content or context.

I am not sure how challenging it is to change the title in this way - but it has merit.

Perhaps some minor changes to the opening statements.

If you are 'gung ho' about a GA submission - I think expanding the title could seriously help. Can a secondary title be placed in this article? I know often one can have a journal article that has a lede and then some kind of secondary naming area.

BeingObjective (talk) 23:48, 23 November 2023 (UTC)


 * Wikipedia is not a journal, and an article should describe a single subject. Therefore, there can be two separate Wikipedia articles:
 * Drug-eluting stent (a device)
 * Interventional Cardiology (a subspecialty of cardiology, an area of medical study)
 * Let me find the rules that explain that; if I would not find, I will ask in the Teahouse. Maxim Masiutin (talk) 00:51, 24 November 2023 (UTC)
 * Here is what I found so far at Contributing to Wikipedia: Each article is on one topic
 * I didn't find an explicit rule that each Wikipedia article should be on one topic, not on multiple topics, but on the Wikipedia's guidelines for creating a new article at Help:Your first article there is a similar provision, although more vaguely defined. It states that "the topic of an article must have already been the subject of publication in reliable, secondary, entirely independent sources that treat the topic in substantive detail". This implies that each article should focus on a single topic that has been substantially covered in reliable sources.
 * There are also notability requirements. I tried to search for "Drug-eluting stents and Interventional Cardiology" as as single subject and didn't find that it is a notable atomic notion.
 * According to the Notability, notability is a test used by editors to decide whether a given topic warrants its own article. Information on Wikipedia must be verifiable; if no reliable, independent sources can be found on a topic, then it should not have a separate article. Furthermore, the page states that "the article title should define what the article is about. If there is enough valid content to fill an article about a person, then that person's name would be an appropriate title. If, however, there is only enough information about one notable event related to the person, then the article should be titled specifically about that event". This, in analogy, implies that each article should focus on a single topic that has been substantially covered in reliable sources. Maxim Masiutin (talk) 01:17, 24 November 2023 (UTC)
 * Interesting - then perhaps just leaving it - fine tuning it as you are doing and then submitting as a GA etc.
 * Seems like you researched the matter - so all is good.
 * I have no problems adding content and offering thoughts and opinions - and I stated that this IMHO is a very important article - in the real world - 1 in three people likely will end up with a 'stent' of some kind in their existence on the planet - seriously, it is (in the US) one of the most common things performed - it is very profitable as a procedure also.
 * The DES - stent distinction is really odd - almost ALL stents are now DES that are used in Interventional cardiology and possibly interventional neurology as of 2023 - and as written, I think this is really emphasized
 * Though to my point - if we scoped this 'strictly' to DES - it would be a fairly short article. I think I struggle a bit with the fact this article - like many others branches into deep dialog about other admittedly related subjects - describing PCI as an example. It is repeatedly, described, discussed in perhaps 20 articles.
 * Let me know what I can provide - I think it looks in decent shape and is certainly a lot better - not sure why it got kind of abandoned - as a dark thought I think a lot of folks - may have died - or simply left WP - weird comment - but I think it all stops at one point.
 * The article on Colonoscopy is similar - in 2009, edits stopped - and it was never a great article - I think it is one that could be brought to GA status as it has in some weird way a narrow scope. I did a fair amount of work on this already.
 * Colonoscopy
 * I would propose this as one to collaborate on - I think this one is actually easier.
 * BeingObjective (talk) 01:52, 24 November 2023 (UTC)
 * Adding connecting information (on Interventional Cardiology) should be OK for Wikipedia. If you wish to write on a combined subject, than it should be done in an academic journal. There is Wikijournal of Medicine which is such a journal that allows publishing articles on Wikipedia. However, to make an review article suitable for an academic journal about Drug-eluting stents and Interventional Cardiology, there should be lot of work to be done. Maxim Masiutin (talk) 02:05, 24 November 2023 (UTC)
 * Perhaps a future effort.
 * As stated - I'd be happy moving the colonoscopy article into a GA pipeline, I think that one is easier and I did a fair amount of work on that one - moved it from 2009 with many more current references - it likely is more about deleting a lot of the noise and keeping it in-scope.
 * BeingObjective (talk) 02:10, 24 November 2023 (UTC)
 * Please think on whether we can expand drug-eluting stent on the following:
 * Comparative effectiveness of the different types of drug-eluting stents available, highlighting differences in terms of drug release mechanisms, efficacy, safety profile, and long-term outcomes.
 * Evolving research areas related to drug-eluting stents technology development or refinements aimed at improving long-term outcomes further reducing restenosis rates (e.g., bioresorbable coatings/drugs).
 * Cost-effectiveness cost-effectiveness of using DES compared to other treatment options over an extended period while considering various parameters like quality-adjusted life years gained and healthcare system costs associated with managing CAD patients.
 * Maxim Masiutin (talk) 02:14, 24 November 2023 (UTC)
 * Let me ponder this more -
 * Though this area-
 * Evolving research areas related to drug-eluting stents technology development or refinements aimed at improving long-term outcomes further reducing restenosis rates (e.g., bioresorbable coatings/drugs).
 * is likely going to be easier for me as far as the value I can add - Abbott & Boston Scientific has done a lot inthe bioresorbable issue - they might have an approved product and it is likely the future for this kind of medical device.
 * I think there was a recall - and development has been problematic. It is from a material science perspective - rather interesting.
 * I think all of the expansion suggestions have merit -
 * Are your thinking of expansion of the existing article or have I missed something?
 * BeingObjective (talk) 02:24, 24 November 2023 (UTC)
 * I think that for GA it should be more than sufficient. My questions are about whether you are willing to invest time to write even better material on drug-eluting stents. If yes, than I'd suggest to copy to Wikijournal. If you are not going to spend more time apart from minor modifications or improvements, than I'd suggest to go to the GA part. What is your opinion? Maxim Masiutin (talk) 02:29, 24 November 2023 (UTC)
 * I'd likely prefer taking a run at a GA submission as plan a. My thinking is - the feedback would be interesting and you suggest the article is 'not that bad' for such an attempt - I do not know the process and seeing what folks say - is of some value. Of course this article really is not mine in the sense it was inherited more or less.
 * So harsh criticism would not be to worrisome to me - as we both agree - writing this from a clean slate - might have been a couple of days work - three tops - so I have no real sense of ownership - what I added was not particularly painful to provide in either time or effort - the problem with WP is that it is not like a journal submission were you get clear credit for something - so I have no 'ego' associated with this document.
 * I assume the options described are not mutually exclusive - I do think I have an interest in new technologies in this area - so both interest and time are not an issue - but perhaps I see this GA submission as a completion of sorts -
 * Hope this thinking makes sense.
 * BeingObjective (talk) 03:04, 24 November 2023 (UTC)
 * OK, let me finish on references for GA then and I will let you know when I finished. Maxim Masiutin (talk) 03:20, 24 November 2023 (UTC)
 * The GA and academic articles are not mutually exclusive but the reqrements are totally different, so it would be like working on two things in parallel, still for GA in my opinion there should not be much to improve by reviewer's suggestions, although it may take a few months until a GA reviewer may take the article. Maxim Masiutin (talk) 03:22, 24 November 2023 (UTC)
 * Understood - and many thanks for adding more dimension to my view of WP.
 * I actually had no clue as to the GA thing. And it does make for a better article and also makes me read some of these rules/policies - I have only been here a month - BeingObjective (talk) 14:04, 24 November 2023 (UTC)
 * To nominate the article, just edit the source code of article Talk page and paste:
 * This is just one action. After you do that, a bot will come to a talk page in a few minutes and do the rest.
 * Here are the instructions on how to nominate: Good article nominations/Instructions - there are other tabs such as "Criteria", etc. Maxim Masiutin (talk) 14:10, 24 November 2023 (UTC)
 * Here are the instructions on how to nominate: Good article nominations/Instructions - there are other tabs such as "Criteria", etc. Maxim Masiutin (talk) 14:10, 24 November 2023 (UTC)

The section on imaging techniques used in PCI.
I think this is fine - it is a big ask to explain a fairly sophisticated set of concepts - I do think IVUS can be used in numerous ways - I think not giving the impression the procedure is done with 'super high fidelity' images is important -

"The interventional cardiologist decides how to treat the blockage in the best way during the PCI/DES placement, based on real-time data. The cardiologist uses imaging data provided by both intravascular ultrasound (IVUS), and fluoroscopic imaging (combined with a radiopaque dye). During the procedure, the information obtained from these two sources enables the cardiologist to track the path of the catheter-DES device as it moves through the arterial blood vessels. This information also helps determine both the location and characteristics of any plaque causing narrowing in the arteries. Data from these two techniques is used to correctly position the stent and to obtain detailed information relating to the coronary arterial anatomy. This is important as such anatomy differs from person to person.This data is recorded on video and may be used in cases when further treatment is needed."

BeingObjective (talk) 22:29, 24 November 2023 (UTC)