How should I treat a bioresorbable vascular scaffold edge restenosis and intra-scaffold dissection?

BACKGROUND: A 71-year-old woman had a scheduled optical coherence tomography (OCT) (ILUMIEN"; St. Jude Medical, St. Paul, MN, USA) follow-up two years after implantation of a 3.0×18 mm bioresorbable vascular scaffold (BVS) (Absorb"; Abbott Vascular, Santa Clara, CA, USA) in the proximal left anterior descending coronary artery. She had dyspnoea corresponding to New York Heart Association (NYHA) Class II. INVESTIGATION: Diagnostic angiography, OCT and fractional flow reserve (FFR) measurement. DIAGNOSIS: OCT showed a covered and embedded BVS (not yet fully resolved after 24 months) and a distal edge in-scaffold restenosis and diffuse disease with an FFR of 0.74. MANAGEMENT: The BVS edge stenosis and the segment with diffuse disease distal to the previously implanted BVS were treated with an additional Absorb BVS 3.0×28 mm overlapping with the BVS implanted two years earlier. Supplementary OCT showed a large intra-scaffold dissection proximal to the overlapping BVS segment; the dissection flap contained the previously implanted BVS.