Talk:Coronary stent

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Wiki Education Foundation-supported course assignment[edit]

This article is or was the subject of a Wiki Education Foundation-supported course assignment. Further details are available on the course page. Student editor(s): Alohaiko, Nchong6.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 18:29, 16 January 2022 (UTC)[reply]

Scope[edit]

Should we cover bare metal stents here or in a separate article to balance up the drug-eluting stent article ? Rod57 (talk) 17:52, 6 September 2008 (UTC)[reply]

Not sure wether the Genous bioengineered stent counts as a bare metal stent (it isnt a DES).

Most of this article is about the stenting procedure rather than the stents themselves. Is that OK ? Rod57 (talk) 17:52, 6 September 2008 (UTC)[reply]

Controversy - Bias[edit]

This article could be made much stronger, especially the controvery section, by discussing four trials: MASS, COURAGE, RAVEL, and SIRIUS[1][2][3][4]. These trials are large multicenter, randomized trials published in core medical journals. MASS and COURAGE find that stenting does not provide better outcomes over medical therapy in terms of all-cause death. In other words, patients do not live any longer. Comparisons generally note marginally better outcomes with respect to angina and exercise tolerance, but it has been long established that treatments for angina demonstrate a strong placebo effect[5][6]. RAVEL and SIRIUS find that DES do not improve survival curves over BMS.

Two additions we might consider:

1) Medical therapy is an alternative therapy to stenting and along with CABG should be mentioned in the section on controversy. The best quality evidence to date, MASS and COURAGE, does not suggest better outcomes for all-cause death and myocardial infarction.

2) It should also be mentioned in the controversy section that evidence from clinical trials comparing BMS with DES does not suggest better survival outcomes for DES over BMS. Although, it should also not that there is a moderate reduction in restenosis for DES.


The article reads with a heavy bias for the SYNTAX trial. I wonder if the investigators created the posting because it is hard to believe that someone would include such a detailed explanation of SYNTAX without bothering to mention the other seminal research studies. Chicagolive (talk) 15:37, 10 July 2009 (UTC)[reply]

This article could stand to have additions to improve the survey on stent research. Although it has been shown in two major trials (COURAGE and MASS-II) that there is no difference in death or MI between PCI, CABG, and medical therapy, we should still recognize that the data may suggest a difference in morbidity.

It is a shallow article if we just include the SYNTAX trial and paint the picture that stenting is the end-all be-all in complex multi-vessel disease. —Preceding unsigned comment added by Chicagolive (talk • contribs) 02:18, 16 September 2009 (UTC)[reply]

Miscellaneous[edit]

Replace source [11] with an available medical journal article over a yahoo news post that has since been removed. Demosa (talk) 18:21, 1 February 2010 (UTC)[reply]

I am uncomfortable with the second sentence of the opening paragraph in that the citation upon which the claims have been made do not actually support this proposition. I recommend deleting this or finding the actual citation which supports this claim.Grisfmr (talk) 23:11, 4 October 2012 (UTC)[reply]

History[edit]

Br Med Bull review. JFW | T@lk 20:30, 12 June 2013 (UTC)[reply]

Requested edits[edit]

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.

After the first paragraph of the page, add the following: Bioresorbable vascular scaffolds, or naturally dissolving stents, have been developed that work similar to permanent stents, but resorb after the artery is healed and able to stay open on its own.

In the Contents section, change “Uses” to “Technique” and add a new section #6 and renumber accordingly: Types of stents

Rename the subhead “Uses” as “Technique”

In the first paragraph under “Uses”, 5th sentence, change “Drug eluting stents” to “Stents”

In the first paragraph under the subhead “Risks and complications”, suggest removing the last sentence (beginning “In order to reduce the treatment …”) or provide substantiation.

In the first paragraph under the subhead “Restenosis,” 4th sentence, change “resorbable stents” to “Naturally dissolving stents”

Suggest deleting 2nd paragraph under the subheading “Restenosis” (starting with “On September 4, 2007…”) as it appears to cite anecdotal sources and is not a particularly relevant topic today (out of date).

In the 1st paragraph under the subheading “Controversy”, 1st sentence, change “hard endpoints” to “deaths or myocardial infarctions” and italicize “angina”.

In the 1st paragraph under the subheading “Controversy”, change the 2nd sentence to: Coronary stents can alleviate angina (chest pain).[7]

In the 1st paragraph under the subheading “Controversy”, suggest deleting the last sentence (beginning “The ‘vast majority …”)

Suggest deleting the 2nd paragraph under the subheading “Controversy” (beginning “A more permanent …”) as it is unrelated to coronary stenting.

In the 3rd paragraph under the subheading “Controversy”, 1st sentence, insert a reference after “GRACE”: [8]

Under the subheading “Research”, delete the introductory paragraph, which is unbalanced and criticizes PCI without balance. Then minimize or abbreviate trials below. Replace with the following: Current research focuses on appropriate patient selection for medication, stenting, or coronary bypass surgery; it also focuses on how to best minimize adverse events when stents are used. Current research also evaluates the effectiveness of new technologies such as diagnostic tools and therapeutics such as naturally dissolving stents and drug eluting balloons. Other relevant research that has been performed compares bare metal stents versus drug eluting stents, the appropriate duration of dual anti-platelet therapy, and coronary bypass surgery versus drug eluting stents.

Under the subheading “Research”, delete the last paragraph and add the following: Other research related to coronary stenting has focused on advancements in stent design, such as the development of naturally dissolving stents, and how best to manage patients medically (duration of dual antiplatelet therapy) after stenting.

Under the subheading “History”, delete the two sentences and add the following: Charles Theodore Dotter and Melvin P. Judkins first described angioplasty in 1964.[9] Stents, in the form of bare-metal stents, were introduced in the late 1980s.[10] Drug-eluting stents were then developed,[11] followed by bioabsorbable polymeric and metallic stents.[12][13][14] Recently drug-eluting bioabsorbable vascular scaffolds, or naturally dissolving stents, have been developed in which the stent resorbs similar to dissolvable stitches.[14] These are different than drug-eluting stents with resorbable polymer coatings that have a bare-metal stent base.

Each new stent generation has been developed to solve issues related to the previous stent generation. For example, bare-metal stents were designed to keep the artery open (prevent recoil) and to treat dissections that occur during angioplasty.[10][15] Drug-eluting stents are designed to accomplish those goals and also limit restenosis, or tissue growth/blockage within the stent.[11] Resorbable scaffolds that are also drug-eluting, such as the Absorb naturally dissolving stent, are designed to have the same advantages of drug-eluting stents while also reducing the risk of future blockages or repeat procedures. In resorbing after the vessel no longer needs the stent, naturally dissolving stents allow the vessel to heal and begin functioning like a normal healthy blood vessel.

After the History section, add the following new section:

Types of Stents[edit]

Traditional bare-metal stents (BMS) provide a mechanical framework that holds the artery wall open, preventing stenosis, or narrowing, of coronary arteries.

Newer drug-eluting stents (DES) are traditional stents with a polymer coating containing drugs that prevent cell proliferation. The antiproliferative drugs are released slowly over time to help prevent tissue growth — which may come in response to the stent — that can block the artery. These types of stents have been shown to help prevent restenosis of the artery through physiological mechanisms that rely upon the suppression of tissue growth at the stent site and local modulation of the body’s inflammatory and immune responses. The first two drug-eluting stents to be utilized were the paclitaxel-eluting stent and the sirolimus-eluting stent, both of which have received approval from the U.S. Food and Drug Administration. Most current FDA-approved drug-eluting stents use sirolimus (also known as rapamycin), everolimus and zotarolimus. Biolimus A9-eluting stents, which utilize biodegradable polymers, are approved outside the U.S.[16].

However, in 2006, clinical trials showed a possible connection between drug-eluting stents and an event known as “late stent thrombosis” where the blood clotting inside the stent can occur one or more years after stent implantation. Late stent thrombosis occurs in 0.9% of patients and is fatal in about one-third of cases when the thrombosis occurs.[17] Increased attention to antiplatelet medication duration[18] and new generation stents (such as everolimus-eluting stents)[19] have dramatically reduced concerns about late stent thrombosis.

Newer-generation PCI technologies aim to reduce the risk of late stent thrombosis or other long-term adverse events. Some DES products market a biodegradable polymer coating with the belief that the permanent polymer coatings of DES contribute to long-term inflammation. Other strategies: A more recent study proposes that, in the case of population with diabetes mellitus — a population particularly at risk — a treatment with paclitaxel-eluting balloon followed by BMS may reduce the incidence of coronary restenosis or myocardial infarction compared with BMS administered alone.[20]

Bioresorbable vascular scaffolds, or naturally dissolving stents, offer an alternative to permanent stents. The Absorb naturally dissolving stent is under study in the United States, but already available in Europe and other markets around the world. Absorb is made of a material similar to dissolvable stitches and is held open by the body's own blood pressure.[21] Studies have shown that a stent is only needed for up to three months after PCI.[22][23] Absorb naturally begins to dissolve in six to 12 months and is completely dissolved in two to three years (two small markers remain to indicate where the stent was placed).[24] As the stent dissolves, the artery is free to respond naturally (dilate/constrict), like a normal blood vessel. .[21][25]

After placement of a stent or scaffold, the patient needs to take two antiplatelet medications (aspirin and one of a few other options) for several months to help prevent blood clots. The ideal length of time a patient needs to be on dual antiplatelet therapy is not fully determined, but recent studies support continuing beyond 12 months unless a patient is at a high risk for bleeding.[26]

In the “See also” section, add a new bullet point for “Absorb Bioresorbable Vascular Scaffold”

References

  1. ^ Hueb, W., N. H. Lopes, et al. (2007). "Five-year follow-up of the Medicine, Angioplasty, or Surgery Study (MASS II): a randomized controlled clinical trial of 3 therapeutic strategies for multivessel coronary artery disease." Circulation 115(9): 1082-9.
  2. ^ Boden, W. E., R. A. O'Rourke, et al. (2007). "Optimal medical therapy with or without PCI for stable coronary disease." N Engl J Med 356(15): 1503-16.
  3. ^ Morice, M. C., P. W. Serruys, et al. (2007). "Long-term clinical outcomes with sirolimus-eluting coronary stents: five-year results of the RAVEL trial." J Am Coll Cardiol 50(14): 1299-304.
  4. ^ Weisz, G., M. B. Leon, et al. (2009). "Five-year follow-up after sirolimus-eluting stent implantation results of the SIRIUS (Sirolimus-Eluting Stent in De-Novo Native Coronary Lesions) Trial." J Am Coll Cardiol 53(17): 1488-97.
  5. ^ Beecher, H. K. (2007). "Surgery as placebo: a quantitative study of bias. 1961." Int Anesthesiol Clin 45(4): 35-45.
  6. ^ Benson, H. and D. P. McCallie, Jr. (1979). "Angina pectoris and the placebo effect." N Engl J Med 300(25): 1424-9.
  7. ^ EFC Guidelines 2014 (PDF)
  8. ^ Steg PG, Kerner A, Van de Werf F; et al. (2008). "Impact of in-hospital revascularization on survival in patients with non-ST-elevation acute coronary syndrome and congestive heart failure". Circulation. 118 (11): 1163–1171. doi:10.1161/CIRCULATIONAHA.108.789685. 18725494. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  9. ^ Dotter CT, Judkins MP (1964). "Transluminal Treatment of Arteriosclerotic Obstruction. Description of a New Technic and a Preliminary Report of Its Application". Circulation. 30: 654–670. 14226164.
  10. ^ a b Sigwart U, Puel J, Mirkovitch V, Joffre F, Kappenberger L.Intravascular stents to prevent occlusion and restenosis after transluminal angioplasty. N Engl J Med. 1987;316(12):701-706.
  11. ^ a b Morice MC, Serruys PW, Sousa JE, et al. A randomized comparison of a sirolimus-eluting stent with a standard stent for coronary revascularization. N Engl J Med. 2002;346(23):1773-1780.
  12. ^ Tamai H, Igaki K, Kyo E; et al. (2000). "Initial and 6-month results of biodegradable poly-l-lactic acid coronary stents in humans". Circulation. 102 (4): 399–404. 10908211. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  13. ^ Erbel R, Di Mario C, Bartunek J; et al. (2007). "Temporary scaffolding of coronary arteries with bioabsorbable magnesium stents: a prospective, non-randomised multicentre trial". Lancet. 369 (9567): 1869–1875. 17544767. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  14. ^ a b Ormiston JA, Serruys PW, Regar E, et al. A bioabsorbable everolimus-eluting coronary stent system for patients with single de-novo coronary artery lesions (ABSORB): a prospective open-label trial. Lancet. 2008;371(9616):899-907.
  15. ^ Serruys PW, de Jaegere P, Kiemeneij F; et al. (1994). "A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease. Benestent Study Group". N Engl J Med. 331 (8): 489–495. 8041413. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  16. ^ Claessen BE, Henriques JP, Dangas GD (2010). "Clinical studies with sirolimus, zotarolimus, everolimus, and biolimus A9 drug-eluting stent systems". Curr Pharm Des. 16 (36): 4012–24. 21208185.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  17. ^ Mauri L, Hsieh WH, Massaro JM, Ho KK, D'Agostino R, Cutlip DE (2007). "Stent thrombosis in randomized clinical trials of drug-eluting stents". N Engl J Med. 356 (10): 1020–1029. 17296821.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  18. ^ Amsterdam EA, Wenger NK, Brindis RG; et al. (2014). "2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines". J Am Coll Cardiol. 64 (24): e139–e228. doi:10.1016/j.jacc.2014.09.017. 25260718. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  19. ^ Palmerini T, Benedetto U, Biondi-Zoccai G; et al. (2015). "Long-Term Safety of Drug-Eluting and Bare-Metal Stents: Evidence From a Comprehensive Network Meta-Analysis". J Am Coll Cardiol. 65 (23): 2496–2507. doi:10.1016/j.jacc.2015.04.017. 26065988. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  20. ^ Mieres J, Fernandez-Pereira C, Risau G; et al. (2012). "One-year outcome of patients with diabetes mellitus after percutaneous coronary intervention with three different revascularization strategies: results from the Diabetic Argentina Registry (DEAR)". Cardiovasc Revasc Med. 13 (5): 265–271. doi:10.1016/j.carrev.2012.06.001. 22796496. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  21. ^ a b Gogas BD, Farooq V, Onuma Y, Serruys PW. The ABSORB bioresorbable vascular scaffold: an evolution or revolution in interventional cardiology? Hellenic J Cardiol. 2012;53(4):301-309
  22. ^ Serruys PW, Luijten HE, Beatt KJ; et al. (1988). "Incidence of restenosis after successful coronary angioplasty: a time-related phenomenon. A quantitative angiographic study in 342 consecutive patients at 1, 2, 3, and 4 months" (PDF). Circulation. 77 (2): 361–371. 2962786. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  23. ^ Asakura M, Ueda Y, Nanto S; et al. (1998). "Remodeling of in-stent neointima, which became thinner and transparent over 3 years: serial angiographic and angioscopic follow-up". Circulation. 97 (20): 2003–2006. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  24. ^ Serruys PW, Onuma Y, Garcia-Garcia HM; et al. (2014). "Dynamics of vessel wall changes following the implantation of the absorb everolimus-eluting bioresorbable vascular scaffold: a multi-imaging modality study at 6, 12, 24 and 36 months". EuroIntervention. 9 (11): 1271–1284. doi:10.4244/EIJV9I11A217. 24291783. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  25. ^ Serruys PW, Ormiston JA, Onuma Y; et al. (2009). "A bioabsorbable everolimus-eluting coronary stent system (ABSORB): 2-year outcomes and results from multiple imaging methods". Lancet. 373 (9667): 897–910. doi:10.1016/S0140-6736(09)60325-1. 19286089. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  26. ^ Mauri L, Kereiakes DJ, Yeh RW; et al. (2014). "Twelve or 30 months of dual antiplatelet therapy after drug-eluting stents". N Engl J Med. 371 (23): 2155–2166. doi:10.1056/NEJMoa1409312. 25399658. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
Please see WP:MEDRS for reference requirements.
Please also make requests one at a time. Best Doc James (talk · contribs · email) 17:36, 3 October 2016 (UTC)[reply]

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BBC Newsnight 18/02[edit]

Documents leaked point to Abbott deliberately skewing data. Fatal events post-stent after 3+ years substantially worse than supposed. Hanoi Road (talk) 22:56, 18 February 2020 (UTC)[reply]

Proposed merger with the article on Drug-eluting stents.[edit]

This article talks broadly to cardiac stenting - and PCI. There is another articles that originally was scoped to Drug-eluting stents. I took the DES article on as a personal project and it has been fleshed out to include PCI and I have also attempted to follow best practices in the layout and structure for a GA type of article.


I am exploring how to merge the articles, they are similar but the DES article is I think a child of the CS article.


Just testing the waters - I think they can be rolled into one document - within the GA framework as described on the DES article tp.


I will approach those editors who last worked with the CS article.


Thoughts, ideas, how to?


Many thanks Dr. BeingObjective (talk) 14:36, 21 November 2023 (UTC)[reply]

On reflection - two articles are better - DES/Coronary Stenting[edit]

Keeping this separate from the DES article - and re-scoping the DES topics to focus on the device and less on the procedure/broader medical context, though they are hard to separate in any clean manner.

This effort is being made in good faith and hopefully in a responsible and professional manner - as a broad comment, a little civility goes a long way. Intentionally ambiguous, but I suspect anyone who has read the thread will be aware of the issue. BeingObjective (talk) 17:56, 21 November 2023 (UTC)[reply]

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