Talk:Drug-eluting stent

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[edit] 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 [1] 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)


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)

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)

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. :) NCurse work 10:39, 23 July 2006 (UTC)

PS:"I hope you're not tired of me announcing my articles here" - NEVER! :) NCurse work 10:42, 23 July 2006 (UTC)
If you don't mind I move this discussion to the article's talk page. NCurse work 18:25, 23 July 2006 (UTC)

[edit] 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.

  • "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.

~ Booya Bazooka 21:08, 23 July 2006 (UTC)

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)

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. NCurse work 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)

[edit] 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)
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)

[edit] 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)

[edit] 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)

[edit] 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)

[edit] 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)


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)

[edit] 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)

[edit] Structure of this important piece

It would be valuable to maintain the credibility of this article, and prevent it turning into a battleground for highly polarized opinions, where editors stake out extreme positions ("CABG is superior to DES for two-vessel disease" -- NOT supported by the majority of clinical research nor by guidelines of the professional bodies) and inflammatory positions ("Legal status: As enthusiasm for these new devices abates...." -- has nothing to do with the "legal" status of the devices, either from a regulatory standpoint nor even from the POV of the plaintiffs' bar.)

It would be valuable to organize this in a rational way -- rather than jumping from history of balloon angioplasty, to pre-clinical investigational bioresorbable stents (in one edit, incorrectly headed as "drug elution"), to "alternative drugs", all before ever saying a word about the DES that are currently available for clinical use, and about which there are thousands of verifiable citations to substantiate a wiki article.

I have cleaned up the structure, written balanced positions on controversial topics, and attempted to restore a sense of decorum.

Nuff said. Debate welcomed here if someone disagrees with my edits. Donsmokem (talk) 01:41, 12 March 2008 (UTC)

I think the page is reasonable tidy enough now to remove the cleanup and advert / coi tags. I agree with the material in the edit by Donsmokem that was reverted at 00:40, March 12, 2008 by Orangemarlin. The Percutaneous coronary intervention and Coronary stent pages could use work too. History of balloon angioplasty shouldn't be included on this page, it should be on one of the parent pages (probably PCI). Dlodge (talk) 12:44, 12 March 2008 (UTC)
Marlin removed a particularly nice piece of the article under Alternatives:" Differences between outcomes with stenting and with coronary bypass grafting (CABG) are a point of controversy. Some studies suggest CABG is superior in multivessel (two or more diseased arteries) coronary artery disease (CAD) as regards a combined endpoint measure of death, myocardial infarction and repeat revascularization.[1] Other studies, including the ARTS II registry, suggest that drug-eluting stenting is not inferior to coronary bypass for treatment of multivessel coronary disease. In all comparison studies of stenting vs. bypass surgery, it is worth noting that only a small minority of patients with multivessel coronary disease have been eligible for inclusion in the studies, and that for most patients, clinical judgement by experienced operators suggests that one or the other approach is preferred." To that end, I have included it above to ask, why exactly that was a bad section? I think it is fairly NPOV, maybe even leaning towards anti-stents given the lack of a citation on the pro-stents end, so why was that removed?Merechriolus (talk) 02:19, 13 March 2008 (UTC)
I added the deleted text back in modified form to balance the alternatives section - I didn't have time to look up the ARTS reference. There should also be some mention of medical management vs. DES here. Any objection to removing the COI / advert & cleanup tags? Dlodge (talk) 04:07, 13 March 2008 (UTC)

Orangemarlin continues to revert and delete every contribution I have made towards neutrality, verifiability, and expertise on the subject. The "legal status" piece is particularly devoid of value. Could someone please guide me towards an appeal process? Donsmokem (talk) 20:54, 14 March 2008 (UTC)

I think this revision of the piece restores the NPOV based on the consensus of Merechriolus and Dlodge. If there is a reason to revert and delete this work again, would the editor please address that reason here and attempt to shift consensus, rather than unilaterally making the change? Thank you. Donsmokem (talk) 02:09, 16 March 2008 (UTC)

Orangemarlin re-applied the advert, clearup, and citation tags. Dlodge and I agree that they can be removed. Consensus? Donsmokem (talk) 03:12, 16 March 2008 (UTC)

And I will continue to do so. This piece is written by Cordis-JNJ. Why else would it be so POV. By the way, why would you think I'm not more or less as expert on this topic as you are? In fact, I can guarantee that I am not only more expert, I am probably one of THE most expert on this topic. Outside of this one article, which I only edit because I noticed so many Cordis IP addresses editing, I stay out of any Cardiology article specifically because I know too much and I would be too POV. Finally, and if you would care, I'm trying to create a WP:MEDMOS for articles on medical devices. A number of medical editors here wanted to use this as a sample article.
If you have a suggestion to create this article in a logical manner, then please go for it. You can read up on WP:MEDMOS which is a manner to standardize the article. For example Legal Issues is just a placeholder name. It can be regulatory, or anything else.
I want the tags to stay. On the other hand, you can find a way to make this article sound less like a JNJ advertisement, we can remove them.. That's all I'm asking.
I would ask that any further personal attacks against me end now. OrangeMarlin Talk• Contributions 03:26, 16 March 2008 (UTC)

No ad-hominem attacks here, orangefish. I'm sure you know something about the field. I do too, including as an editor of a high-impact journal in the field. I believe that it is free of pro-JNJ, pro-BSCI, pro-DES bias. If you could point to the word, words, lines, or concepts that sound to you like advertising, I am sure that the community of legitimate experts in the field will do something about it. Donsmokem (talk) 03:58, 16 March 2008 (UTC)

I don't edit medical articles with POV pushers and those who engage in personal attacks. Please enjoy your editing. OrangeMarlin Talk• Contributions 08:53, 16 March 2008 (UTC)
...though you could be helpful and point out the statement in question, because this has caught my interest too.Merechriolus (talk) 21:37, 16 March 2008 (UTC)

If no one else advocates for retaining the tags, then we ought to remove them. Donsmokem (talk) 12:30, 16 March 2008 (UTC)

I completely agree with the revisions that Dlodge made to the "Alternatives" section. The structure seems basically sound to me. The stent thrombosis issue could be 10 pages long if editors wanted to expand it, but I think it's factual and neutral now. Citations still need a little clean-up, then it ought to stand as a Good Article. Donsmokem (talk) 00:12, 17 March 2008 (UTC)

[edit] Addition of new citation

ORIGINAL TEXT:Just for the record, I am preempting the reversions of my recent addition of the citation [22] 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)

[edit] 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)