SCAI Expert Consensus Statement on Management of In-Stent Restenosis and Stent Thrombosis

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Biomedical Engineering

Background:

• Stent failure, encompassing in-stent restenosis and stent thrombosis, remains a significant limitation of coronary stenting.
• Despite advancements in stent design and coatings, in-stent restenosis persists as a common clinical problem with substantial healthcare costs and adverse outcomes.
• Stent thrombosis leads to abrupt artery closure, increasing the risk of myocardial infarction and death.

Purpose of the Study:

• To provide updated practical algorithmic approaches for managing in-stent restenosis and stent thrombosis.
• To present a pragmatic outline for the assessment and management of patients experiencing stent failure.
• To propose a new time-sensitive classification for in-stent restenosis with mechanistic implications.

Main Methods:

• Development of a new classification system for in-stent restenosis based on timing and mechanism.
• Emphasis on the frequent use of intracoronary imaging for precise etiological determination.
• Algorithmic approach to patient assessment and management of stent failure.

Main Results:

• A new time-sensitive classification for in-stent restenosis is proposed.
• Intracoronary imaging is highlighted as crucial for guiding treatment selection.
• Image-guided stenting at initial implantation is recommended to minimize future stent failure.

Conclusions:

• Accurate diagnosis of stent failure etiology through imaging and timing is critical for effective treatment.
• The Society for Cardiovascular Angiography & Interventions (SCAI) recommends updated management strategies for stent failure.
• Proactive use of intracoronary imaging during initial stenting and for subsequent failure events is advised.