How should I treat progression of disease of the jailed left anterior descending ostium after bioresorbable vascular scaffold implantation in the left circumflex?

A 60-year-old male re-presented with stable angina (CCS class II) and equivocal exercise treadmill test 12 months after undergoing previous elective percutaneous coronary intervention (PCI) with implantation of a bioresorbable vascular scaffold (BVS) for ostial and proximal left circumflex (LCx) lesions. Other past medical history of note included diabetes mellitus, chronic kidney disease (CKD) stage 4 and hypertension.

With regard to his index procedure, he had undergone elective PCI for CCS III stable angina with implantation of a 3.0×28 mm Absorb (Abbott Vascular, Santa Clara, CA, USA) BVS for an ostial and proximal left circumflex (LCx) lesion with final left main stem bifurcation kissing balloon inflation (KBI). According to optical coherence tomography (OCT) findings, prior to KBI, the left anterior descending artery (LAD) orifice was jailed
by BVS struts. Hence, KBI with a 3.0×20 mm non-compliant (NC) (left main coronary artery [LMCA]-LCx) and a 2.5×20 mm NC balloon (LMCA-intermediate) was performed. Though repeat OCT imaging post-KBI was not obtained due to background CKD, the final angiogram indicated an excellent result.