Absorb vs. DESolve: an optical coherence tomography comparison of acute mechanical performances

The aim of the study was to compare retrospectively the acute mechanical performance of the Absorb vs. DESolve scaffolds in terms of appropriate deployment with OCT.

Final post-deployment OCT pullbacks of consecutive patients treated with either Absorb or DESolve were reviewed. The following parameters were calculated and compared: mean and minimal lumen area (MLA), residual in-scaffold area stenosis (RAS), incomplete strut apposition (ISA), tissue prolapse area, eccentricity index, asymmetry index, strut fracture and edge dissection. A total of 72 patients were included. The Absorb group consisted of 35 patients treated with 63 Absorb scaffolds and was compared to a well-matched group of 37 patients treated with 50 DESolve scaffolds. Baseline characteristics did not differ significantly between the two groups. Procedural characteristics were different with respect to maximal balloon inflation pressure (Absorb vs. DESolve: 21.5±0.4 atm vs. 16.8±3.8 atm, p<0.01) and mean NC balloon diameter used for post-dilatation (Absorb vs. DESolve 3.3±0.4 mm vs. 3.5±0.4 mm, p<0.01). OCT analysis showed similar MLA (Absorb vs. DESolve: 5.8±1.9 mm2 vs. 6.1±2.6 mm2, p=0.43) and mean luminal area (Absorb vs. DESolve: 7.1±2.2 mm2 vs. 7.2±1.9 mm2, p=0.77). The mean eccentricity index was 0.85±0.05 with Absorb and 0.80±0.05 with DESolve, p<0.01. There was no difference in the incidence of overall ISA. A smaller prolapse area was found with Absorb (Absorb vs. DESolve 1.0±1.1 mm2 vs. 3.6±6.2 mm², p<0.01).

The two scaffolds showed similar MLA while there was a trend towards a lower RAS and a larger maximum and minimum scaffold diameter with DESolve. The DESolve scaffold was more eccentric as compared to the Absorb. These results might be related to the DESolve's unique expansion properties or they may reflect baseline and procedural differences which cannot be excluded in a retrospective study. Randomised studies are needed to address this aspect.