Talk:Drug-eluting stent

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An entry from Drug-eluting stent appeared on Wikipedia's Main Page in the Did you know? column on 26 July 2006.

Contents 1 Marketing 2 Jargon 3 Comment and suggestion 4 Question/comment

[edit] Marketing

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! —The preceding unsigned comment was 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)