Drug-Eluting Stents: Technical and Clinical Progress

Round 1

Reviewer 1 Report

Koźlik et al had a good view on he current status of coronary stents with deep focus on their structure, materials and technological process. I enjoy the manuscript. The used references are appropriate and adequate. They are also recent. The English is good. There are some minor typo errors. Please check.The manuscript organizing is good.

The manuscript needs some images or figure in my opinion. For such a good study it would be beneficial to use some figures (original or permitted)

Author Response

Dear Reviewer,

Thank You very much for Your review.

We put all the details in the file attached to this message.

Yours Sincerely,

Maciej Koźlik

Author Response File: Author Response.docx

Reviewer 2 Report

Reviewer’s Comments:

The manuscript “Impact of Stent Material, Strut Design and Coating Techniques on Cardiovascular Outcomes” is a very interesting work. In this work, Drug eluting stents (DES) demonstrated superior efficacy when compared to bare metal stents and plain old balloon angioplasty and are nowadays used in almost all percutaneous revascularization procedures. The design of the stent platforms constantly improves to maximize its efficacy and safety. Constant development of DES includes adoption of new materials used for scaffold production, new design types, improved overexpansion abilities, new polymers coating and finally improved antiproliferative agents. Especially nowadays, with the immensity of available DES platforms it is crucial to understand how different aspects of stents impact the effect of their implantation, as subtle differences between various stent platforms could alternate the most important issue - clinical outcomes. While I believe this topic is of great interest to our readers, I think it needs major revision before it is ready for publication. So, I recommend this manuscript for publication with major revisions.

1. In this manuscript, the authors did not explain the importance of the Coating Techniques in the introduction part. The authors should explain the importance of Coating Techniques.

2) Title: The title of the manuscript is not impressive. It should be modified or rewritten it.

3) Correct the following statement “This review discusses the current status of coronary stents with deep focus on their structure, materials and technological process”.

4) Keywords: The Coating Technique is missing in the keywords. So, modify the keywords.

5) Introduction part is not impressive. The references cited are very old. So, Improve it with some latest literature like 10.1016/j.molstruc.2021.131145, 10.3389/fchem.2022.1023316

6) The authors should explain the following statement with recent references, “When crown angle exceeds 150° the stent crowns are almost completely straightened which indicates that the device is reaching its physical limit”.

7) Add space between magnitude and unit. For example, in synthesis “21.96g” should be 21.96 g. Make the corrections throughout the manuscript regarding values and units.

8) The author should provide reason about this statement “In addition, some polymers are applied solely on the abluminal side of the stent, lowering the chance of interaction between plasma and polymer molecules and therefore are believed to reduce the risk of potential adverse events even further”.

9. Comparison of the present results with other similar findings in the literature should be discussed in more detail. This is necessary in order to place this work together with other work in the field and to give more credibility to the present results.

10) Conclusion part is very long. Make it brief and improve by adding the results of your studies.

 

11) There are many grammatic mistakes. Improve the English grammar of the manuscript.

Author Response

Dear Reviewer,

Thank You very much for Your review.

We put all the details in the file attached to this message.

Yours Sincerely,

Maciej Koźlik

Author Response File: Author Response.docx

Reviewer 3 Report

The paper presents an overview of the principal characteristics affecting the efficacy of coronary stents. The paper is well written and interesting. It should be improved considering the following points:

-        figures could help to better understand some descriptions and considerations. In particular, it could be useful to add figures with 1) stress strain curves comparing the mechanical behavior of different metals used for stent production (SS, Cr-Co, Pt-Cr); 2) comparison between open and closed cell stents, 3) geometry of the stents presented in Table 1; 4) geometry of stents ad hoc developed for bifurcations, 5) details of the surfaces of BP-DES, DP-DES, PF-DES the porous surface of a nanotextured stent.

 -        in Table 1 it is missed the unit of measure of the polymer thickness. Moreover, the polymer distribution id introduced without any explanation of the meaning of “abluminal” and “conformal”. This column should be moved in Table 2, after that in the text the two concepts are introduced. Also in this case a figure illustrating the difference between the two configurations could be useful.

 

-        In Table 1 it is not specified if the stents are open or closed cell. Are there still closed cell coronary stents on the market? If yes, could you include also them?

 

-        how the stents in Table 1 have been selected? Are they all the stents on the market or not? Please clarify. The same for Table 2.

 

 -        In Figure 1 only few stents are reported. Why? What is the rationale of this choice? It would be more interesting if the information were available for all the stents in Table 1. Also, could you comment on why some stents have a wide range of overexpansion and others do not?

 

 -        Among the platforms specifically designed for bifurcations only  BIOSS LIM C (Balton, Poland) is cited. Please add  others and discuss the differences

 

-        Please explain better how the Resolute Integrity zotarolimus-eluting stent and the Resolute Onyx zotaro-276 limus-eluting stent work.

 

 -        In Table 2 there are some characters in red. Please change the color. One of the most interesting pieces of information in Table 2 is the huge difference in the release time of different drugs, an aspect that would deserve a more extensive discussion than has been done in the paper.

 

-        Please explain the meaning of “mTOR signaling pathway”

 

 Finally, at the end of the paper a useful conclusion is lacking. In the abstract the authors wrote: “  Especially nowadays, with the immensity of available DES platforms it is crucial to understand how different aspects of stents impact the effect of their implantation, as subtle differences between various stent platforms could alternate the most important issue  - clinical outcomes.”  Even if it is not simple, as the authors noticed in the section of conclusions, please try to use all the data collected in the paper for giving some indications on how different properties of stents affect the clinical outcomes.  Without this final effort the review lack of a real interest, it is only a list of different stents with different properties

 

Author Response

Dear Reviewer,

Thank You very much for Your review.

We put all the details in the file attached to this message.

Yours Sincerely,

Maciej Koźlik

Author Response File: Author Response.docx