SCAI Releases Guidance on Management of In-Stent Restenosis and Stent Thrombosis

May 26, 2023—The Society for Cardiovascular Angiography & Interventions (SCAI) recently announced the release of an expert consensus on the management of in-stent restenosis and stent thrombosis. The statement was published online by Lloyd W. Kline, MD, et al in JSCAI.

Amif Lofti, MD, who is senior author of the manuscript, commented in the SCAI press release, “As always, our first goal is to follow the best evidence to try to prevent or decrease risk of in-stent restenosis or stent thrombosis. The goal of this document was to develop a meaningful algorithm, based on the best currently available evidence, for the interventional cardiologist in the management of in-stent restenosis and stent thrombosis.” Dr. Lofti is Chief of Cardiology at Baystate Health in Springfield, Massachusetts.

According to SCAI, the document suggests updated practical algorithmic approaches to in-stent restenosis and stent thrombosis. The writing group presents a pragmatic outline of the assessment and management of patients presenting with stent failure. Additionally, they propose a new SCAI classification that is time-sensitive with mechanistic implications of in-stent restenosis.

The document places an emphasis on the frequent use of intracoronary imaging and assessment of timing to determine the precise etiology, because that information is crucial to guide selection of the best treatment option.

SCAI recommends image-guided coronary stenting at the time of initial implantation to minimize the occurrence of stent failure. When in-stent restenosis and stent thrombosis are encountered, imaging should be strongly considered to optimize the subsequent approach, advised SCAI in the press release.