title: ABSORB biodegradable stents versus second-generation metal stents: a comparison study of 100 complex lesions treated under OCT guidance.
abstract: OBJECTIVE
  The aim of this study was to compare the acute performance of the PLLA ABSORB bioresorbable vascular scaffold (BVS) (Abbott Vascular, Santa Clara, California) with second-generation metal drug-eluting stents (DES) in complex coronary artery lesions.
  
  
  BACKGROUND
  Thick polymer-based BVS have different mechanical properties than thin second-generation DES. Data on the acute performance of BVS are limited to simple coronary lesions treated in trials with strict inclusion criteria.
  
  
  METHODS
  Fifty complex coronary lesions (all type American College of Cardiology/American Heart Association B2-C) treated with a BVS undergoing a final optical coherence tomography (OCT) examination were compared with an equal number of matched lesions treated with second-generation DES. The following stent performance indexes were assessed with OCT: mean and minimal area, residual area stenosis (RAS), incomplete strut apposition (ISA), tissue prolapse, eccentricity index, symmetry index, strut fracture, and edge dissection.
  
  
  RESULTS
  One hundred lesions from 73 patients were analyzed. A higher balloon diameter/reference vessel diameter ratio was used for predilation in the BVS group (p < 0.01). Most of the BVS and DES were post-dilated with short noncompliant (NC) balloons of similar diameter. OCT showed in the BVS group a higher tissue prolapse area (p = 0.08) and greater incidence of ISA at the proximal edge (p = 0.04) with no difference in the overall ISA. The RAS was 20.2% in the BVS group and 21.7% in the DES group (p = 0.32). There was no difference in the eccentricity index. The minimal and mean lumen areas were similar in the 2 groups. Two cases of strut fractures occurred after the BVS, whereas none was observed in the DES.
  
  
  CONCLUSIONS
  Based on OCT, the BVS showed similar post-procedure area stenosis, minimal lumen area, and eccentricity index as second-generation DES. The different approach for lesion preparation and routine use of OCT guidance during BVS expansion may have contributed to these results.
authors: NIHR Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom; Department of Heart and Vessels, AOUC Careggi, Florence, Italy.
authors: Alessio
authors: A
authors: Mattesini
authors: NIHR Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom; Department of Clinical and Experimental Medicine, University of Eastern Piedmont, Novara, Italy.
authors: Gioel G
authors: GG
authors: Secco
authors: NIHR Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.
authors: Gianni
authors: G
authors: Dall'Ara
authors: NIHR Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.
authors: Matteo
authors: M
authors: Ghione
authors: NIHR Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.
authors: Juan C
authors: JC
authors: Rama-Merchan
authors: Department of Clinical and Experimental Medicine, University of Eastern Piedmont, Novara, Italy.
authors: Alessandro
authors: A
authors: Lupi
authors: NIHR Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.
authors: Nicola
authors: N
authors: Viceconte
authors: NIHR Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.
authors: Alistair C
authors: AC
authors: Lindsay
authors: NIHR Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.
authors: Ranil
authors: R
authors: De Silva
authors: National Heart Centre Singapore, Singapore.
authors: Nicolas
authors: N
authors: Foin
authors: Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.
authors: Toru
authors: T
authors: Naganuma
authors: Department of Heart and Vessels, AOUC Careggi, Florence, Italy.
authors: Serafina
authors: S
authors: Valente
authors: Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.
authors: Antonio
authors: A
authors: Colombo
authors: NIHR Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom. Electronic address: c.dimario@rbht.nhs.uk.
authors: Carlo
authors: C
authors: Di Mario
mesh_terms: D020341:Absorbable Implants; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation*; D016022:Case-Control Studies; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000473:pathology / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D007558:Italy; D019344:Lactic Acid; D008131:London; D008297:Male; D008670:Metals; D008875:Middle Aged; D011091:Polyesters; D011108:Polymers; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011474:Prosthesis Design; D011475:Prosthesis Failure; D015607:Stents; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome
chemical_list: D008670:Metals; D011091:Polyesters; D011108:Polymers; D019344:Lactic Acid; C033616:poly(lactide)
keywords: bioresorbable vascular scaffold; drug-eluting stent; optical coherence tomography; stent