Case report
Coronary artery aneurysm formation following implantation of a bioresorbable vascular scaffold for in-stent restenosis
Desenvolvimento de aneurisma coronário após o implante de scaffold reabsorvível como tratamento de reestenose intra-stent
Marcos García-Guimaraes
, Javier Cuesta, Teresa Alvarado, Fernando Rivero, Teresa Bastante, Amparo Benedicto, Fernando Alfonso
Corresponding author
Cardiology Department, Hospital Universitario de La Princesa, Madrid, Spain
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(B) control angiography showing moderate in-stent restenosis (white arrow) and formation of a coronary artery aneurysm (yellow arrow).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Marcos García-Guimaraes, Javier Cuesta, Teresa Alvarado, Fernando Rivero, Teresa Bastante, Amparo Benedicto, Fernando Alfonso" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Marcos" "apellidos" => "García-Guimaraes" ] 1 => array:2 [ "nombre" => "Javier" "apellidos" => "Cuesta" ] 2 => array:2 [ "nombre" => "Teresa" "apellidos" => "Alvarado" ] 3 => array:2 [ "nombre" => "Fernando" "apellidos" => "Rivero" ] 4 => array:2 [ "nombre" => "Teresa" "apellidos" => "Bastante" ] 5 => array:2 [ "nombre" => "Amparo" "apellidos" => "Benedicto" ] 6 => array:2 [ "nombre" => "Fernando" "apellidos" => "Alfonso" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2174204917301757" "doi" => "10.1016/j.repce.2016.05.013" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917301757?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117303499?idApp=UINPBA00004E" "url" => "/08702551/0000003600000006/v2_201706240150/S0870255117303499/v2_201706240150/en/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S2174204917301769" "issn" => "21742049" "doi" => "10.1016/j.repce.2016.09.016" "estado" => "S300" "fechaPublicacion" => "2017-06-01" "aid" => "1008" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Rev Port Cardiol. 2017;36:475.e1-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2297 "formatos" => array:3 [ "EPUB" => 205 "HTML" => 1734 "PDF" => 358 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Successful percutaneous closure of a residual atrial septal defect due to device failure" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "475.e1" "paginaFinal" => "475.e3" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Encerramento percutâneo de comunicação interauricular residual por falência de dispositivo" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1914 "Ancho" => 3333 "Tamanyo" => 539931 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(A and D) Three- (3D TEE) and two-dimensional transesophageal echocardiography images showing residual shunt through the device (22 mm Ultrasept ASD Occluder<span class="elsevierStyleSup">®</span>); (B and C) delivery sheath through the Ultrasept device in fluoroscopic view and in 3D TEE; (E and F) closure of residual shunt in the 22 mm Ultrasept device with a 20 mm Ultrasept PFO device, with the final result documented in fluoroscopic view and in 3D TEE.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Sílvia Aguiar Rosa, Filipa Ferreira, Lídia de Sousa, António Fiarresga, José Diogo Martins, Ana Galrinho, Ana Agapito, Paula Fazendas, Fátima F. Pinto, Rui Cruz Ferreira" "autores" => array:10 [ 0 => array:2 [ "nombre" => "Sílvia" "apellidos" => "Aguiar Rosa" ] 1 => array:2 [ "nombre" => "Filipa" "apellidos" => "Ferreira" ] 2 => array:2 [ "nombre" => "Lídia" "apellidos" => "de Sousa" ] 3 => array:2 [ "nombre" => "António" "apellidos" => "Fiarresga" ] 4 => array:2 [ "nombre" => "José Diogo" "apellidos" => "Martins" ] 5 => array:2 [ "nombre" => "Ana" "apellidos" => "Galrinho" ] 6 => array:2 [ "nombre" => "Ana" "apellidos" => "Agapito" ] 7 => array:2 [ "nombre" => "Paula" "apellidos" => "Fazendas" ] 8 => array:2 [ "nombre" => "Fátima F." "apellidos" => "Pinto" ] 9 => array:2 [ "nombre" => "Rui Cruz" "apellidos" => "Ferreira" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0870255117303505" "doi" => "10.1016/j.repc.2016.09.020" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117303505?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917301769?idApp=UINPBA00004E" "url" => "/21742049/0000003600000006/v1_201707020042/S2174204917301769/v1_201707020042/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S2174204917301745" "issn" => "21742049" "doi" => "10.1016/j.repce.2016.11.012" "estado" => "S300" "fechaPublicacion" => "2017-06-01" "aid" => "1015" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "rev" "cita" => "Rev Port Cardiol. 2017;36:465-72" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3372 "formatos" => array:3 [ "EPUB" => 156 "HTML" => 2775 "PDF" => 441 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review Article</span>" "titulo" => "Mid-regional pro-adrenomedullin and ST2 in heart failure: Contributions to diagnosis and prognosis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "465" "paginaFinal" => "472" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "A MR-proadrenomedulina e o ST2 na insuficiência cardíaca: contribuição para o diagnóstico e prognóstico" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1050 "Ancho" => 2500 "Tamanyo" => 139993 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Schematic representation of the production and actions of adrenomedullin (ADM) in heart failure (HF). The pressure/volume overload and ventricular wall stretching seen in HF lead to upregulation of the ADM gene. The preprohormone undergoes cleavage, forming pro-ADM, which is further processed to ADM. ADM causes natriuresis, diuresis, and vasodilation. It is also associated with reduced hypertrophy, ventricular remodeling and fibrosis. The actions of ADM thus have a cardioprotective effect. Due to its in vitro instability, ADM levels cannot be measured directly, but cleavage of pro-ADM also produces mid-regional pro-adrenomedullin, a stable fragment that is easily measured and whose concentrations reflect those of ADM. ADM: adrenomedullin; MR-proADM: mid-regional pro-adrenomedullin.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Daniela Lopes, Luiz Menezes Falcão" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Daniela" "apellidos" => "Lopes" ] 1 => array:2 [ "nombre" => "Luiz" "apellidos" => "Menezes Falcão" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0870255116302323" "doi" => "10.1016/j.repc.2016.11.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255116302323?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917301745?idApp=UINPBA00004E" "url" => "/21742049/0000003600000006/v1_201707020042/S2174204917301745/v1_201707020042/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Coronary artery aneurysm formation following implantation of a bioresorbable vascular scaffold for in-stent restenosis" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "473.e1" "paginaFinal" => "473.e4" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Marcos García-Guimaraes, Javier Cuesta, Teresa Alvarado, Fernando Rivero, Teresa Bastante, Amparo Benedicto, Fernando Alfonso" "autores" => array:7 [ 0 => array:4 [ "nombre" => "Marcos" "apellidos" => "García-Guimaraes" "email" => array:1 [ 0 => "marcos.garcia.guimaraes@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Javier" "apellidos" => "Cuesta" ] 2 => array:2 [ "nombre" => "Teresa" "apellidos" => "Alvarado" ] 3 => array:2 [ "nombre" => "Fernando" "apellidos" => "Rivero" ] 4 => array:2 [ "nombre" => "Teresa" "apellidos" => "Bastante" ] 5 => array:2 [ "nombre" => "Amparo" "apellidos" => "Benedicto" ] 6 => array:2 [ "nombre" => "Fernando" "apellidos" => "Alfonso" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Cardiology Department, Hospital Universitario de La Princesa, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Desenvolvimento de aneurisma coronário após o implante de <span class="elsevierStyleItalic">scaffold</span> reabsorvível como tratamento de reestenose <span class="elsevierStyleItalic">intra-stent</span>" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 2190 "Ancho" => 2334 "Tamanyo" => 408351 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">(A and B) Angiographic result after implantation of a bioresorbable vascular scaffold (BVS) in the proximal left anterior descending coronary artery (small white arrows indicate the ends of the BVS); (C and D) at nine-month follow-up formation of a coronary artery aneurysm (yellow arrow) is demonstrated in the mid segment of the BVS.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Case 1</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 45-year-old man with previous history of hyperlipidemia was admitted with an inferior myocardial infarction requiring implantation of a drug-eluting stent (DES) in the mid right coronary artery. One year later he presented with angina and angiography demonstrated severe in-stent restenosis (ISR). After lesion predilation with a cutting balloon, a 3.5 mm×18 mm bioresorbable vascular scaffold (BVS) (Absorb, Abbott Vascular, CA) was implanted and postdilated up to 24 atm using a non-compliant balloon, with an excellent final result (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A). Optical coherence tomography (OCT) confirmed appropriate expansion and apposition of the BVS, with a minor intimal dissection at its proximal edge. The patient remained completely asymptomatic, but at nine months underwent a scheduled angiography that revealed moderate ISR of the BVS. In addition, a coronary artery aneurysm (CAA) was detected immediately proximal to the BVS location (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>B). OCT showed the presence of an heterogeneous pattern of neointimal hyperplasia (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>A and B) and confirmed the origin of the CAA immediately proximal to the BVS edge (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>C and D). Interestingly, a minor rupture with intraluminal thrombus was also detected at the origin of the CAA. As fractional flow reserve was 0.79 and instantaneous wave-free ratio was 0.93, and the patient denied any symptoms, the lesion was not treated. During follow-up, a stress echocardiogram was negative.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case 2</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 67-year-old man with hyperlipidemia was admitted for effort angina. Fifteen years before he had suffered an anterior myocardial infarction and a bare-metal stent (BMS) was implanted in the proximal left anterior descending coronary artery. Coronary angiography revealed proliferative ISR involving the proximal segments of the BMS but also extending 10 mm into the proximal vessel. OCT depicted severe neoatherosclerosis, with heavily calcified plaques, and a thin-cap fibroatheroma in the proximal segment. After aggressive lesion predilation the entire segment was covered with a 3.5 mm×23 mm BVS (Absorb, Abbott Vascular, CA), postdilated using a non-compliant balloon up to 24 atm, with an excellent final result (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>A and B). OCT confirmed correct BVS expansion with a small residual coronary dissection behind the BVS and at its proximal border. The patient remained completely asymptomatic but a scheduled control angiogram at nine months revealed the development of a large CAA in the mid portion of the BVS (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>C and D). OCT provided unique additional insights, revealing a CAA 11 mm in length with a maximum lumen area of 27.5 mm<span class="elsevierStyleSup">2</span>. Notably, a striking displacement of the BVS struts was depicted, confirming the occurrence of BVS fracture (<a class="elsevierStyleCrossRef" href="#fig0020">Figure 4</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0015" class="elsevierStylePara elsevierViewall">CAA formation is very rare after stent implantation. The prevalence of this complication after DES implantation ranges between 0.76 and 1.25%.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">1,2</span></a> Different pathophysiological mechanisms have been implicated in the development of CAA, including extensive vessel wall injury (particularly major underlying coronary dissections), excessive positive vessel remodeling, hypersensitivity reactions, stent fractures and even local infection.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> The role of the eluting drug and polymer appears crucial. The same factors have been implicated in the few cases of CAA development after BVS reported to date.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">3,4</span></a> In our patients BVS-related dissections may have been implicated in the pathogenesis of this entity. Moreover, in the second patient the major underlying vessel disruption may have promoted BVS fracture. The Restenosis Intrastent: Bioresorbable Vascular Scaffolds Treatment (RIBS VI) study (an ongoing multicenter registry on the use of BVS for ISR) will provide further insight into the safety and efficacy of BVS in this challenging anatomic scenario.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Ethical disclosures</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Protection of human and animal subjects</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Confidentiality of data</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Right to privacy and informed consent</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflicts of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres859479" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec853587" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres859480" "titulo" => "Resumo" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec853588" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Case 1" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case 2" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:3 [ "identificador" => "sec0020" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0035" "titulo" => "Right to privacy and informed consent" ] ] ] 8 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-04-05" "fechaAceptado" => "2016-05-15" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec853587" "palabras" => array:4 [ 0 => "Optical coherence tomography" 1 => "Bioresorbable vascular scaffolds" 2 => "In-stent restenosis" 3 => "Coronary artery aneurysm" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec853588" "palabras" => array:4 [ 0 => "Tomografia de coerência ótica" 1 => "Suportes vasculares biorreabsorbíveis" 2 => "Reestenose <span class="elsevierStyleItalic">intra-stent</span>" 3 => "Aneurisma coronário" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Coronary artery aneurysm (CAA) formation is a rare complication of coronary intervention that may develop after implantation of bare-metal or drug-eluting stents. The etiology of this entity appears to be multifactorial and its prognosis is poorly understood, but it has been associated with an increased risk of stent thrombosis. To date few cases of CAAs related to bioresorbable vascular scaffold (BVS) implantation have been reported, and the development of CAA after BVS implantation for the treatment of in-stent restenosis (ISR) has not been previously described. Here we present two cases of CAA formation after BVS, which represent the first demonstration of CAA formation after the use of BVS for ISR.</p></span>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A formação de um aneurisma coronário (CAN) é uma complicação rara após intervenções coronárias. O CAN pode se desenvolver após <span class="elsevierStyleItalic">stent</span> convencional (BMS) e implante de <span class="elsevierStyleItalic">stent</span> farmacológico (DES). A etiologia desta patologia parece ser multifatorial e o prognóstico permanece mal elucidado, mas tem sido associado com um aumento do risco de trombose de <span class="elsevierStyleItalic">stent</span>. Até à data, apenas alguns casos de CAN relacionadas com <span class="elsevierStyleItalic">scaffold</span> bioabsorvível (BVS) foram relatados. O desenvolvimento de CAN após o implante de um BVS para o tratamento da reestenose <span class="elsevierStyleItalic">intra-stent</span> (ISR) não foi anteriormente descrito. Aqui apresentamos dois casos de formação CAN após a BVS, que representam a primeira demonstração de formação CAN após o uso da BVS para ISR.</p></span>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1068 "Ancho" => 2334 "Tamanyo" => 223618 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(A) Coronary angiogram of the right coronary artery showing the result of bioresorbable vascular scaffold implantation (small white arrows); (B) control angiography showing moderate in-stent restenosis (white arrow) and formation of a coronary artery aneurysm (yellow arrow).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1455 "Ancho" => 3001 "Tamanyo" => 564167 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Optical coherence tomography images showing (A and B) an heterogeneous pattern of neointimal hyperplasia with a minimum lumen area (LA) of 2.1 mm<span class="elsevierStyleSup">2</span>; (C and D) formation of a coronary artery aneurysm (CAA) at the proximal border of the bioresorbable vascular scaffold (BVS) with a maximum LA of 17.6 mm<span class="elsevierStyleSup">2</span>. A minor rupture with associated intraluminal thrombus was visualized (small yellow arrow) (C); (E) longitudinal view depicting the segment with in-stent restenosis (white arrow) and the CAA (yellow arrow) at the edge of the BVS. * denotes wire artefact. LA: lumen area.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 2190 "Ancho" => 2334 "Tamanyo" => 408351 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">(A and B) Angiographic result after implantation of a bioresorbable vascular scaffold (BVS) in the proximal left anterior descending coronary artery (small white arrows indicate the ends of the BVS); (C and D) at nine-month follow-up formation of a coronary artery aneurysm (yellow arrow) is demonstrated in the mid segment of the BVS.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1710 "Ancho" => 3017 "Tamanyo" => 538750 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">(A-D) Optical coherence tomography images of the coronary artery aneurysm (CAA) (yellow arrow) with a maximum lumen area of 27.5 mm<span class="elsevierStyleSup">2</span>. Some struts of the bioresorbable vascular scaffold appear covered but largely malapposed (A, thin yellow arrow), others were extensively displaced (B), whereas no struts could be detected in other areas of the CAA (C); (D) longitudinal view. * denotes wire artefact. LA: lumen area.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Coronary aneurysms after drug-eluting stent implantation: clinical, angiographic, and intravascular ultrasound findings" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "F. Alfonso" 1 => "M.J. Perez-Vizcayno" 2 => "M. Ruiz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2009.01.069" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2009" "volumen" => "53" "paginaInicial" => "2053" "paginaFinal" => "2060" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19477355" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0030" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidence and natural history of coronary artery aneurysm developing after drug-eluting stent implantation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C.M. Ahn" 1 => "B.K. Hong" 2 => "J.Y. Kim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ahj.2010.07.013" "Revista" => array:6 [ "tituloSerie" => "Am Heart J" "fecha" => "2010" "volumen" => "160" "paginaInicial" => "987" "paginaFinal" => "994" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21095290" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0035" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Development and receding of a coronary artery aneurysm after implantation of a fully bioresorbable scaffold" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S. Nakatani" 1 => "Y. Ishibashi" 2 => "P. Suwannasom" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.114.014257" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2015" "volumen" => "131" "paginaInicial" => "764" "paginaFinal" => "767" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25712060" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0040" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Late coronary BVS malapposition and aneurysm: a time for appraisal" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "B. Cortese" 1 => "P.S. Orrego" 2 => "R. Virmani" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Cath Cardiovasc Interv" "fecha" => "2015" "volumen" => "86" "paginaInicial" => "678" "paginaFinal" => "681" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003600000006/v1_201707020042/S2174204917301757/v1_201707020042/en/main.assets" "Apartado" => array:4 [ "identificador" => "9919" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case Reports" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003600000006/v1_201707020042/S2174204917301757/v1_201707020042/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917301757?idApp=UINPBA00004E" ]
| Year/Month | Html | Total | |
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