Coronary stenting has transformed revascularization strategy, producing excellent procedural and clinical outcomes in myriad clinical settings. Despite these proven short- and long-term benefits, in-stent restenosis (ISR) and stent thrombosis (ST) continue to be limitations. There remains no definitive management approach for either condition despite a greater understanding of the underlying mechanisms ensuing from advances in intracoronary imaging.

In this SCAI Expert Consensus Statement, practical algorithmic approaches to ISR & ST are offered. A pragmatic outline of assessment and management of patients presenting with stent failure is presented. A new SCAI Classification of a time-sensitive classification with mechanistic implications of ISR is proposed. Emphasis is placed on frequent use of intracoronary imaging and assessment of timing to determine the precise etiology, as that information is crucial to guide selection of the best treatment option.

All authors: Lloyd W Klein, MD, MSCAI; Sandeep Nathan, FSCAI; Akiko Maehara, FSCAI; John Messenger, FSCAI; Gary S Mintz, MD; Ziad Ali, MD, PhD, FSCAI; Jennifer Rymer, FSCAI; Yader Sandoval, FSCAI; Karim Al-Azizi, FSCAI; Roxana Mehran, MSCAI; Sunil V Rao, MSCAI; and Amir Lotfi, MD, FSCAI.