Talk:Drug-eluting stent/GA1

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Reviewer: NikosGouliaros (talk · contribs) 20:34, 7 March 2024 (UTC)[reply]

Thank you, looking forward for hearing from you soon! Maxim Masiutin (talk) 23:36, 7 March 2024 (UTC)[reply]

Warning icon Our mutual replies were here and there and impossible for anyone other than us to follow, so I've arranged them in sections, keeping them time-stamped. Hope this helps.Please let's keep our replies in the section they are meant for. NikosGouliaros (talk) 21:56, 19 March 2024 (UTC)[reply]

General

Note that this is my first GA review; I am prepared to be corrected or withdraw if experienced editors believe I am off-base. Also note I am not a native English speaker.

There is no doubt a lot of work has been put to this article on a magnificent device, which performs two complicated functions together (vessel scaffolding and gradual drug emitting), and has been described as a "multidiscipllinary success story"[a][1], so congratulations to its contributors. However, I humbly express my skepticism that it can be brought to GA status in the time frame of a GA review. In my opinion there are some gaps in the coverage of the topic, coupled with undue weight placed on peripheral aspects of it. For now, I am explaining my general thoughts on the article content, and then taking a closer look at the Lead, as an idea of what more detailed fact-checking, reference-checking and copy-editing could look like for the rest of it.

So, starting from the big picture: Drug eluting stent follows, to some extent, the Manual of Style on medicine-related articles as regards the article layout; there, medical devices are grouped with drugs and treatments, and I'd argue this isn't very helpful, as this layout is clearly made for medications. Crucially, it lacks a section on the description of the device, and the different types it comes in. One can compare similar GAs: The only Good Articles on a medical device are Dental implant, which has a "composition" section right after "uses"; and Injector pen, with a "design" section in the same place. Another instance of a somewhat similarly themed Good Article is Brachytherapy, which has a section on "types". (No Featured Articles with helpful thematic similarities are found). So, I think this article is definitely missing a section dedicated to describing the device (I expand on some potential ways of describing it later on), and its different subtypes. More specifically, this section could also mention:

  • the materials it is made of (with a word on the role of polymers in drug delivery, and perhaps mentioning the corresponding stent types, including polymer-free stents, and bioresorbable stents)[2]: 49 
  • perhaps the word "struts", including some of the info currently in Research directions
  • the actual pharmaceutical compounds they emit
  • the fact that some DES (the majority) are balloon-expandable, but a few ones, including the very first one in 1986, are self-expanding,[b][3]: 7 [4]: 43–44 
  • the distinction between coronary and peripheral stents.

I'd argue the section on description I'm proposing would be better suited after Uses (like in the aforementioned GAs), since Uses is the section that also gives background info on atherosclerosis and restenosis, two essential concepts to grasp what's behind DES design.

So, moving on to Uses: I think it needs a little more general background on atherosclerosis, without jumping directly to coronary artery disease; nonetheless, specific info on symptoms and signs (under the heading Clinical indications) feel a bit non-relevant to the article. Also, from this point on, the section feels like coming from an article on PCI, not DES. Importantly: but for a brief lead reference, the article ignores the use of drug eluting stents (DES) in peripheral arterial interventions, and only covers coronary interventions. It couldn't reasonably pass GA review without expanding its breadth of coverage to the role of DES in peripheral arterial disease, relatively limited though it is.[5][6]: 57–59 [7]: 56  The obvious place for this is probably [[Drug eluting stent#Uses]|this section].

The Clinical Procedure section is welcome; I wonder if being somewhat less detailed could help it. The section on Efficacy feels not necessary: much of it just repeats info already given, or that could reasonably fit elsewhere; on the other had, it could merge with Complications into an Outcomes section. I'm also skeptical on the role of Design considerations: it reads a bit like a foreword to a manufacturer's manual. The info including in the Alternatives section could either be missing or fit in Uses.

History is of course welcome, but I wonder if some of the material in the first three paragraphs could be shortened.

I am now thinking on how can I edit the lead to implement your suggestions. Maxim Masiutin (talk) 00:28, 16 March 2024 (UTC)[reply]
@NikosGouliaros, did my edits resolve your concerns? Should I do further edits if I didn't fix all your observations, or you have further concerns? By the way, according to WP:GAN/I#R3, in the case of a marginally non-compliant nomination, if the problems are easy to resolve, the reviewer may be bold and fix them immediately. The Good Article review is designed to be a lightweight process. Its primary goal is to assess whether an article meets the GA criteria, which cover the main aspects of article quality such as accuracy, neutrality, completeness, and style, but it does not require the article to be perfect. The reviewer checks the article against the GA criteria, focusing on aspects like verifiability, broad coverage, neutrality, stability, and good writing. There is always improvement opportunity: even after an article passes the GA review, it can still be improved. Editors are encouraged to continue refining articles to higher standards. In contrast, the Featured Article (FA) review is more rigorous: it involves a more thorough examination, and the criteria are more stringent, aiming for professional standards of writing, presentation, and sourcing. The FA process is intended to identify Wikipedia's very best work as examples for other articles to follow. Looking for your feedback. Maxim Masiutin (talk) 00:12, 19 March 2024 (UTC)[reply]
@Maxim Masiutin: Your edits are to the right direction, and this GA review looks like it can eventually end with a pass. It just takes some time to review and re-review. Thank you for your kind and well-meant responses, and also for your patience with my overzealous concerns. I'm trying to keep it simple and not more heavyweight than appropriate. NikosGouliaros (talk) 21:56, 19 March 2024 (UTC)[reply]

Lead

  • As a whole, the lead could benefit from some editing: concepts and terms are introduced in non-optimal succession, and with repetitions. Examples thereof:
    • 1st paragraph: "It releases drugs to prevent the growth of scar tissue and reduce the risk of stent restenosis..."; followed by "A drug-eluting stent is different from other types of stents because it has a coating that delivers medication..."
    • "...can be inserted into blocked or narrowed arteries through a catheter placed in a peripheral artery"; followed, two paragraphs later, by "PCI uses larger peripheral arteries in the arms or the legs to thread a catheter..."
    • 3rd paragraph: " As of 2023, more than 90 percent of stents used in PCI procedures were DES."; followed, in the next paragraph, by "DES devices are a primary choice of interventional cardiologists and..."
    • 4th paragraph: "...superior to prior non-drug eluting or bare-metal stents", followed by "DES products hold an advantage over BMS offerings."
  • First sentence: The word tube, on its own, brings to my mind the image of a continuous hose; The Concise Oxford Medical Dictionary does define a stent as 'a tube... [which] may be a simple tube, usually plastic, or an expandable, usually sprung mesh metal, tube';[8] however, vascular stents specifically are in mesh form;[9]: 528–531  in other words, they are a tubular mesh. A great dscription of stents is "hollow cylinders, usually fabricated from metal meshes that are inserted in a collapsed state across a site of arterial blockage and stretched open by inflating an angioplasty balloon".[1] Also, I'm not sure if the first sentence is successful in giving a concise idea of the stent concept. A great word for defining and describing stents is scaffold, as in "stents act as a scaffold on the inner arterial wall to prevent early and late vascular remodeling";[10]: 1271  or a mechanical support device.[3]: 4  Also, the first sentence has a pair of adjacent wikilinks; I think a more specific link to atherosclerosis solves the problem.
  • "A DES is often made of metal alloys and can be inserted into blocked or narrowed arteries through a catheter placed in a peripheral artery, such as in the arm or leg. DES is fully integrated with a catheter delivery system and is viewed as one integrated medical device." Mentioning a "peripheral artery" as a catheter entrance site means clearly that the sentence speaks of coronary angioplasty. I'll expand later, but vascular stents aren't only used in coronary arteries, but also in peripheral ones, albeit much less commonly. In my mind, one needs to first speak of (and link to) angioplasty in general, and perhaps also of balloons and then of coronary angioplasty. Otherwise, it's a short of hysteron proteron.
  • "Drug-eluting stents in current use were approved by the FDA after clinical trials demonstrated...": Mentioning FDA in the lead is unnecessary, and against global perspective.
  • "There is significant clinical data relating to the use and outcomes of DES, general stents, PCI and coronary artery bypass graft (CABG) surgery." This sentence seems written for the article on coronary artery disease, or revascularization, not DES.
  • Lead references:
    • All three citations at the end of the first paragraph are of low quality (a news article from a medical journal and two industry websites), and are redundant.
    • "As of 2023, more than 90 percent of stents used in PCI procedures were DES." This fact, which isn't mentioned in the main body of the article, is not supported by the cited reference. I'm not saying it's wrong: "B[are]M[etal]S[tent]s are currently used in 10% to 20% of patients undergoing PCI.[10]: 1279 
    • Citation 6 is a primary source, so also has no point in the lead section. There are more recent, secondary sources on the superiority of DES over BMS.[11]
    • Citations 8-10 are from controversial or non-Pubmed-indexed journals.

These are some first thoughts. Looking forward to some reaction! NikosGouliaros (talk) 21:04, 8 March 2024 (UTC)[reply]

Thank you, please let me resolve all your concerns in 1-2 days. Maxim Masiutin (talk) 21:14, 8 March 2024 (UTC)[reply]
Please be aware that the the list criteria for the article to be GA is short and exhaustive, the reviewers should not impose as mandatory . additional requirements beyound what is specified in the GA criteria. Suggestions that exceed GA criteria are always welcome, but they should not serve grounds as specifying the "Fail" result. Besides that, you can also help other people to help via Wikipedia talk:Good article nominations. I saw you made a post in the Wikiproject Medicine, which is good, however, I found out that the people in Wikipedia talk:Good article nominations are much more responsive than those in the Wikiproject Medicine.
I'm now working on your objections, please let me resolve them. Maxim Masiutin (talk) 04:30, 10 March 2024 (UTC)[reply]
I indeed used a Petscan tools to look for the articles in the "Implants (medicine)" category that also have "Good articles" or "Featured articles" category. There was indeed only Dental implant in both "Implants (medicine)" and "Good articles" category, and there were no "Features articles" that were also present in the "Implants (medicine)" category. I have a suspicion that there are articles about implants that were not included formally into the "Implants (medicine)" category, that's why we can't find any. Maxim Masiutin (talk) 20:18, 10 March 2024 (UTC)[reply]
Upon your review, I made the correction: the article tells that the tube made of a mesh-like material. Is that OK? Or we should something? My email and access works properly, sometimes errror happen when qn editor' is turned off.Please let me now there I can payfo r it? Maxim Masiutin (talk) 20:39, 10 March 2024 (UTC)[reply]
I am sorry that I wasn't able to finish addressing all your issues in 1-2 days. If you have time, can you please mark the review on hold for 5 more days, so I will finish by that time, otherwise, ff you would like to finish the review quickly, can you please conclude the review as "Fail", after that I will improve the article and re-nominate them again? I will also discuss in the Wikiproject Medicine how to deal with medical devices and/or implants. Maxim Masiutin (talk) 10:26, 11 March 2024 (UTC)[reply]
Sure, no rush. I need time to review the changes myself, though they seem to the right direction! NikosGouliaros (talk) 21:07, 11 March 2024 (UTC)[reply]
So, the canges are definitely in the right direction, but the ones in the lead somewhat less so than the rest. In the lead, and especially in the first paragraph, the reader is not eased perfectly smoothly into the subject. Repetitions seem to still be a problem:; for example: The stent slowly releases a drug to prevent re-blockage of the artery is followed by The release of the drug from the stent to prevent the growth of scar tissue and reduce the risk of stent restenosis, which is the narrowing of the stented area of an artery after treatment: this repeats less than it expands on the previous sentence, but the first paragraph of the lead might not be the perfect place for expanding; directly follows A drug-eluting stent is different from other types of stents because it has a coating that delivers medication directly to the arterial wall., which is saying pretty much the same. Moreover, the first paragraph describes the stent insertion procedure, before the reader becomes acquainted with the concept of atherosclerosis and perhaps angioplasty.
Now, I do wonder if I'm imposing personal preferences or arbitrary stylistic ideas as I'm reviewing the prose quality of the lead. But do you think you could re-edit it a bit, with the above in mind, and we can decide together if the product works better?
Thoughts? NikosGouliaros (talk) 20:25, 14 March 2024 (UTC)[reply]
I reworked the lead section, based on your observation. I made it more straightforward, shorter and more intelligible, removing the repetition and improving the information flow. I made the lead consists of 3 sections: introduction, on drug release and on application/PCI.
Please let me know whether I should improve the lead further.
Let us finish with the lead before we can proceed to the other sections. Maxim Masiutin (talk) 22:04, 16 March 2024 (UTC)[reply]
I finished work on the lead yesterday, I hope I have fixed all your concerns about the lead. I also removed the "Summary" sub-title from the "Design" sections. Overall, I hope that I have addressed all the concerns that you gave here. Maxim Masiutin (talk) 14:58, 17 March 2024 (UTC)[reply]
Thanks for heeding my suggestions and of course for your work. Making the lead more compact has greatly helped! I'll go ahead and myself make some mostly factual corrections (described in their edit summaries - we can discuss any of them). This honestly looks good; I still have some misgivings on the references though: A GA, and a lead, doesn't need to be perfectly cited; I will only insist on a reference for the fact that As of 2023, more than 90 percent of stents used in PCI procedures were DES, as I can't find where the source[12] mentions this, and it is a challengeable piece of info. NikosGouliaros (talk) 22:33, 17 March 2024 (UTC)[reply]
Thank you very much for pointing out unsourced information at the lead about the percentage figures (90%) in 2023. I removed the unsourced information from the lead about the year 2023, and put the percentage use into the history section, as the data was in fact from 2005-2006, not 2023. This data about 2005 may be of historical intereste, but it is no longer relevant in the lead.
I also put appropriate sources to the lead on multiple DES use on a single patient, and copied this data from the lead to the body, putting appropriate sources for that. Maxim Masiutin (talk) 23:23, 17 March 2024 (UTC)[reply]
Thank you, please fix the information as you wish, I'd be grateful.
You wrote that per GA the lead should not be fully cited, however, in this case, there should be that information duplicated in the body where it should be cited and this information should be easy to find. Maxim Masiutin (talk) 23:38, 17 March 2024 (UTC)[reply]

Design

I added the "Design" section that briefly covers the issues that you've raised. Maxim Masiutin (talk) 17:40, 11 March 2024 (UTC)[reply]

The section on design is a very very welcome addition. Its coverage of the main aspects of stent design is very good. Do you think the subsection titled "Summary" is necessary? It feels as if written for a stent-design manual; and the title is obviously inappropriate. NikosGouliaros (talk) 20:25, 14 March 2024 (UTC)[reply]
In Uses Design, I do believe the whole section previously titled "Summary" (from In designing a DES to add further complexity to design considerations), and not just the heading, should go; it is somewhat manual-like, it repeats already given info, and it feels a bit in violation of GA criterion 3b. But I'm willing to be convinced differently.
Getting back on the rest of the sections! NikosGouliaros (talk) 22:33, 17 March 2024 (UTC)[reply]
Please also let me delete or rewrite the information from "In designing a DES" to "add further complexity to design considerations", let me think on how should I fix it. Maxim Masiutin (talk) 23:24, 17 March 2024 (UTC)[reply]
I rewritten the paragraph in the Design section, the new paragraph starts with "DES is a sophisticated medical device with several key properties". Please let me know whether this style is OK, or I should improve/fix it, or delete such paragraph altogether. Maxim Masiutin (talk) 23:36, 17 March 2024 (UTC)[reply]
I also rearranged the material in the "Design" section for logical flow. Maxim Masiutin (talk) 08:15, 19 March 2024 (UTC)[reply]
@Maxim Masiutin: As it is, the design section is definitely good. I'm only making a minor clarification on peripheral DESs. Also, give me some time to check some of the sources. NikosGouliaros (talk) 21:56, 19 March 2024 (UTC)[reply]

Uses

The first paragraph in Uses is so much better!NikosGouliaros (talk) 20:25, 14 March 2024 (UTC)[reply]
I added information on both coronary stents and peripheral stents, in the uses section, and also added some background on atherosclerosis. Maxim Masiutin (talk) 00:27, 16 March 2024 (UTC)[reply]


Notes

  1. ^ References are provided as optional suggestions. DOIs of book chapters can be used to find the full text at websites that Wikipedia does not endorse.
  2. ^ Unreliable/Predatory Source Detector marks some of my book sources as marginally reliable; I honestly believe that, for the info I'm citing them on, they are acceptable. More opinions welcome.

References

  1. ^ a b Burt, HM; Hunter, WL (2006). "Drug-eluting stents: a multidisciplinary success story". Adv. Drug Deliv. Rev. 58 (3): 350–357. doi:10.1016/j.addr.2006.01.014. PMID 16546288. Retrieved 7 March 2024.
  2. ^ King, MW; Bambharoliya, T; et al. (2020). Coronary Artery Disease and The Evolution of Angioplasty Devices. Cham: Springer. doi:10.1007/978-3-030-42443-5. ISBN 978-3-030-42443-5. Retrieved 8 March 2024.
  3. ^ a b McCormick, C (2017). "Overview of cardiovascular stent designs". In Wall, G; Podbielska, H; et al. (eds.). Functionalised Cardiovascular Stents. Woodhead Publishing. pp. 1–26. doi:10.1016/B978-0-08-100496-8.00001-9. ISBN 9780081004982. Retrieved 5 March 2024.
  4. ^ Mao, H; Bao, J (2018). "Peripheral Stent". In Jing, Z; Mao, H (eds.). Endovascular Surgery and Devices. Springer. pp. 43–57. doi:10.1007/978-981-10-8270-2_5. ISBN 9811082707. Retrieved 5 March 2024.
  5. ^ Velagapudi, C; Madassery, S (November 2022). "Drug-eluting stents" (PDF). Semin Intervent Radiol. 39 (4): 400–405. doi:10.1055/s-0042-1758078. PMID 36406018. Retrieved 3 March 2024.
  6. ^ Nordanstig, J; Behrendt, CA; et al. (January 2024). "Editor's Choice -- European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Asymptomatic Lower Limb Peripheral Arterial Disease and Intermittent Claudication". Eur J Vasc Endovasc Surg. 67 (1): 9–96. doi:10.1016/j.ejvs.2023.08.067. PMID 37949800. Retrieved 3 March 2024.
  7. ^ Katib, N; Varcoe, RL (2023). "Intervention for chronic lower limb ischemia". In Loftus, I; Hinchliffe, RJ (eds.). Vascular and Endovascular Surgery (7th ed.). Elsevier Health Sciences. pp. 39–57. ISBN 9780702084638. Retrieved 4 March 2024.
  8. ^ Martine, E, ed. (2015). Concise medical dictionary (Ninth ed.). Oxford: OUP. p. 718. ISBN 9780191059575. Retrieved 4 March 2024.
  9. ^ Raphael, CE; El-Sabbagh,, A (2020). "Chapter 24 - Emerging therapies in coronary balloon angioplasty, stenting, and bioabsorbable scaffolds". In Nussinovitch, U (ed.). Emerging Technologies for Heart Diseases (1st ed.). Academic Press. pp. 527–557. doi:10.1016/B978-0-12-813704-8.00024-3. ISBN 9780128137055. Retrieved 3 March 2024.{{cite book}}: CS1 maint: extra punctuation (link)
  10. ^ a b Mauri, L; Bhatt, DL; et al. (2018). "62. Percutaneous coronary intervention". In Tomaselli, D; Zipes, P; et al. (eds.). Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine (11th ed.). Elsevier. pp. 1271–1294. ISBN 9780323555937. Retrieved 4 March 2024.
  11. ^ Piccolo, R; Bonaa, KH (June 2019). "Drug-eluting or bare-metal stents for percutaneous coronary intervention: a systematic review and individual patient data meta-analysis of randomised clinical trials". Lancet. 393 (10190): 2503–2510. doi:10.1016/S0140-6736(19)30474-X. PMID 31056295. Retrieved 6 March 2024.
  12. ^ Koźlik M, Harpula J, Chuchra PJ, Nowak M, Wojakowski W, Gąsior P (February 2023). "Drug-Eluting Stents: Technical and Clinical Progress". Biomimetics. 8 (1): 72. doi:10.3390/biomimetics8010072. PMC 9944483. PMID 36810403.

Follow-up questions

Hello, NikosGouliaros! I hope I resolved your concerns and objections one week ago. Do you have any more concerns that I have to address? Are you expecting any action for me for these last 5-7 days? Please let me know how should I proceed. Maxim Masiutin (talk) 20:39, 25 March 2024 (UTC)[reply]

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