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with a minor intimal dissection at its proximal edge&#46; The patient remained completely asymptomatic&#44; but at nine months underwent a scheduled angiography that revealed moderate ISR of the BVS&#46; In addition&#44; a coronary artery aneurysm &#40;CAA&#41; was detected immediately proximal to the BVS location &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>B&#41;&#46; OCT showed the presence of an heterogeneous pattern of neointimal hyperplasia &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>A and B&#41; and confirmed the origin of the CAA immediately proximal to the BVS edge &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>C and D&#41;&#46; Interestingly&#44; a minor rupture with intraluminal thrombus was also detected at the origin of the CAA&#46; As fractional flow reserve was 0&#46;79 and instantaneous wave-free ratio was 0&#46;93&#44; and the patient denied any symptoms&#44; the lesion was not treated&#46; During follow-up&#44; a stress echocardiogram was negative&#46;</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&#46; Fifteen years before he had suffered an anterior myocardial infarction and a bare-metal stent &#40;BMS&#41; was implanted in the proximal left anterior descending coronary artery&#46; Coronary angiography revealed proliferative ISR involving the proximal segments of the BMS but also extending 10 mm into the proximal vessel&#46; OCT depicted severe neoatherosclerosis&#44; with heavily calcified plaques&#44; and a thin-cap fibroatheroma in the proximal segment&#46; After aggressive lesion predilation the entire segment was covered with a 3&#46;5 mm&#215;23 mm BVS &#40;Absorb&#44; Abbott Vascular&#44; CA&#41;&#44; postdilated using a non-compliant balloon up to 24 atm&#44; with an excellent final result &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>A and B&#41;&#46; OCT confirmed correct BVS expansion with a small residual coronary dissection behind the BVS and at its proximal border&#46; 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 &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>C and D&#41;&#46; OCT provided unique additional insights&#44; revealing a CAA 11 mm in length with a maximum lumen area of 27&#46;5 mm<span class="elsevierStyleSup">2</span>&#46; Notably&#44; a striking displacement of the BVS struts was depicted&#44; confirming the occurrence of BVS fracture &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Figure 4</a>&#41;&#46;</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&#46; The prevalence of this complication after DES implantation ranges between 0&#46;76 and 1&#46;25&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">1&#44;2</span></a> Different pathophysiological mechanisms have been implicated in the development of CAA&#44; including extensive vessel wall injury &#40;particularly major underlying coronary dissections&#41;&#44; excessive positive vessel remodeling&#44; hypersensitivity reactions&#44; stent fractures and even local infection&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> The role of the eluting drug and polymer appears crucial&#46; The same factors have been implicated in the few cases of CAA development after BVS reported to date&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">3&#44;4</span></a> In our patients BVS-related dissections may have been implicated in the pathogenesis of this entity&#46; Moreover&#44; in the second patient the major underlying vessel disruption may have promoted BVS fracture&#46; The Restenosis Intrastent&#58; Bioresorbable Vascular Scaffolds Treatment &#40;RIBS VI&#41; study &#40;an ongoing multicenter registry on the use of BVS for ISR&#41; will provide further insight into the safety and efficacy of BVS in this challenging anatomic scenario&#46;</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&#46;</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&#46;</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&#46;</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&#46;</p></span></span>"
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          "titulo" => "Case 2"
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        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Discussion"
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          "titulo" => "Ethical disclosures"
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              "identificador" => "sec0025"
              "titulo" => "Protection of human and animal subjects"
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              "identificador" => "sec0030"
              "titulo" => "Confidentiality of data"
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            2 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Right to privacy and informed consent"
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          "titulo" => "References"
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            0 => "Optical coherence tomography"
            1 => "Bioresorbable vascular scaffolds"
            2 => "In-stent restenosis"
            3 => "Coronary artery aneurysm"
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          "palabras" => array:4 [
            0 => "Tomografia de coer&#234;ncia &#243;tica"
            1 => "Suportes vasculares biorreabsorb&#237;veis"
            2 => "Reestenose <span class="elsevierStyleItalic">intra-stent</span>"
            3 => "Aneurisma coron&#225;rio"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Coronary artery aneurysm &#40;CAA&#41; formation is a rare complication of coronary intervention that may develop after implantation of bare-metal or drug-eluting stents&#46; The etiology of this entity appears to be multifactorial and its prognosis is poorly understood&#44; but it has been associated with an increased risk of stent thrombosis&#46; To date few cases of CAAs related to bioresorbable vascular scaffold &#40;BVS&#41; implantation have been reported&#44; and the development of CAA after BVS implantation for the treatment of in-stent restenosis &#40;ISR&#41; has not been previously described&#46; Here we present two cases of CAA formation after BVS&#44; which represent the first demonstration of CAA formation after the use of BVS for ISR&#46;</p></span>"
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      "pt" => array:2 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A forma&#231;&#227;o de um aneurisma coron&#225;rio &#40;CAN&#41; &#233; uma complica&#231;&#227;o rara ap&#243;s interven&#231;&#245;es coron&#225;rias&#46; O CAN pode se desenvolver ap&#243;s <span class="elsevierStyleItalic">stent</span> convencional &#40;BMS&#41; e implante de <span class="elsevierStyleItalic">stent</span> farmacol&#243;gico &#40;DES&#41;&#46; A etiologia desta patologia parece ser multifatorial e o progn&#243;stico permanece mal elucidado&#44; mas tem sido associado com um aumento do risco de trombose de <span class="elsevierStyleItalic">stent</span>&#46; At&#233; &#224; data&#44; apenas alguns casos de CAN relacionadas com <span class="elsevierStyleItalic">scaffold</span> bioabsorv&#237;vel &#40;BVS&#41; foram relatados&#46; O desenvolvimento de CAN ap&#243;s o implante de um BVS para o tratamento da reestenose <span class="elsevierStyleItalic">intra-stent</span> &#40;ISR&#41; n&#227;o foi anteriormente descrito&#46; Aqui apresentamos dois casos de forma&#231;&#227;o CAN ap&#243;s a BVS&#44; que representam a primeira demonstra&#231;&#227;o de forma&#231;&#227;o CAN ap&#243;s o uso da BVS para ISR&#46;</p></span>"
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Optical coherence tomography images showing &#40;A and B&#41; an heterogeneous pattern of neointimal hyperplasia with a minimum lumen area &#40;LA&#41; of 2&#46;1 mm<span class="elsevierStyleSup">2</span>&#59; &#40;C and D&#41; formation of a coronary artery aneurysm &#40;CAA&#41; at the proximal border of the bioresorbable vascular scaffold &#40;BVS&#41; with a maximum LA of 17&#46;6 mm<span class="elsevierStyleSup">2</span>&#46; A minor rupture with associated intraluminal thrombus was visualized &#40;small yellow arrow&#41; &#40;C&#41;&#59; &#40;E&#41; longitudinal view depicting the segment with in-stent restenosis &#40;white arrow&#41; and the CAA &#40;yellow arrow&#41; at the edge of the BVS&#46; &#42; denotes wire artefact&#46; LA&#58; lumen area&#46;</p>"
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          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">&#40;A and B&#41; Angiographic result after implantation of a bioresorbable vascular scaffold &#40;BVS&#41; in the proximal left anterior descending coronary artery &#40;small white arrows indicate the ends of the BVS&#41;&#59; &#40;C and D&#41; at nine-month follow-up formation of a coronary artery aneurysm &#40;yellow arrow&#41; is demonstrated in the mid segment of the BVS&#46;</p>"
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          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">&#40;A-D&#41; Optical coherence tomography images of the coronary artery aneurysm &#40;CAA&#41; &#40;yellow arrow&#41; with a maximum lumen area of 27&#46;5 mm<span class="elsevierStyleSup">2</span>&#46; Some struts of the bioresorbable vascular scaffold appear covered but largely malapposed &#40;A&#44; thin yellow arrow&#41;&#44; others were extensively displaced &#40;B&#41;&#44; whereas no struts could be detected in other areas of the CAA &#40;C&#41;&#59; &#40;D&#41; longitudinal view&#46; &#42; denotes wire artefact&#46; LA&#58; lumen area&#46;</p>"
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                      "titulo" => "Coronary aneurysms after drug-eluting stent implantation&#58; clinical&#44; angiographic&#44; and intravascular ultrasound findings"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "F&#46; Alfonso"
                            1 => "M&#46;J&#46; Perez-Vizcayno"
                            2 => "M&#46; Ruiz"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    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"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19477355"
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              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
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                    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
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                            0 => "C&#46;M&#46; Ahn"
                            1 => "B&#46;K&#46; Hong"
                            2 => "J&#46;Y&#46; Kim"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ahj.2010.07.013"
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                        "fecha" => "2010"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21095290"
                            "web" => "Medline"
                          ]
                        ]
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              "referencia" => array:1 [
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                      "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&#46; Nakatani"
                            1 => "Y&#46; Ishibashi"
                            2 => "P&#46; Suwannasom"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCULATIONAHA.114.014257"
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                        "tituloSerie" => "Circulation"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25712060"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Late coronary BVS malapposition and aneurysm&#58; a time for appraisal"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "B&#46; Cortese"
                            1 => "P&#46;S&#46; Orrego"
                            2 => "R&#46; Virmani"
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                        ]
                      ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
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